Cold injury residuals is exposure to low environmental temperatures (freezing) resulting in tissue damage. The tissue damage from ice crystals may involve skin, subcutaneous tissue, and deeper layer structures such as muscle, nerves and blood vessels. If injury is only to the skin and tissue just below, it is considered to be superficial.

The causative factor is exposure to the cold without sufficient protection from clothing. People are more susceptible to the injury if they are hungry, have cardiovascular problems, and are exhausted, dehydrated or intoxicated with alcohol.

In superficial frostbite, there is tingling, numbness, possible superficial blisters, and white skin that turns blue-gray. In deeper frostbite, the affected area is white, cold, hard, and numb at first. As warming begins, the part becomes painful, blotchy-red, and blisters form that are filled with either serum or blood. Deeper tissue freezing usually causes dry gangrene and gives an appearance of a hard black covering (eschar) over the area.

When rewarming is completed, the use of angiography, magnetic resonance imaging (MRI) or the Doppler flowmeter may be used to determine the adequacy of peripheral circulation to guide treatment, and to help improve the outcome.

Treatment measures for superficial and deep forms of the condition are as follows:

• Superficial frostbite: Treatment can very simply consist of rewarming the affected area with a warm object, putting the affected fingers in the armpits, or removing the footwear, rewarming the area, and then applying warm socks.

• Deep frostbite: Treatment of the condition requires hospital care as soon as possible. Extremities that are severely frostbitten should be rapidly rewarmed in large containers of water 38 to 43 degrees C (100 to 110 degrees F). Prevention of infection is vital, and dry gangrene is less susceptible to infection than wet gangrene. Tetanus toxoid booster may be needed as well as antibiotics. When rewarming is complete, the extremities are kept dry, in as sterile an environment as possible, and open to the air. Most patients are dehydrated, and require fluids either by mouth or intravenously (IV). The microcirculation needs to be restored. Use of anti-inflammatory drugs and plasma volume expanders may be helpful. The affected areas should not be rubbed as this increases tissue damage.

Any degree of frostbite may result in long-term symptoms of sensitivity to cold, excessive sweating (hyperhidrosis), irregular nail growth, and numbness. After recovery, cold-injured persons may exhibit symptoms of Raynaud's syndrome (see Diagnostic Code: 7117 Raynaud's syndrome). Amputations are a possibility in deep frostbite. Because this tissue resembles a burn, there is a chance of skin cancer (squamous cell) developing at a later time.

• Residuals of Cold Injury

  • General. Injury by cold causes structural and functional disturbances of small blood vessels, cells, nerves, skin, and bone. Exposure to damp cold (temperatures around freezing) causes frostnip and immersion (trench) foot. Exposure to dry cold (temperatures well below freezing) causes frostbite. In severe cases there may be loss of fingers, toes, earlobes, tip of nose, etc. The physical effects of exposure may be acute or chronic, with immediate or latent manifestations. The fact that the immediate effects of cold injury may have been characterized as "acute" or "healed" does not preclude development of disability at the original site of injury many years later.

  • Chronic Effects of Exposure. Veterans with a history of cold injury may experience the following signs and symptoms at the site of the original injury: chronic fungus infection of the feet, disturbances of nail growth, hyperhidrosis, chronic pain of the causalgia type, abnormal skin color or thickness, cold sensitization, joint pain or stiffness, Raynaud's phenomenon, weakness of hands or feet, night pain, weak or fallen arches, edema, numbness, paresthesias, breakdown or ulceration of cold injury scars, vascular insufficiency (indicated by edema, shiny, atrophic skin, or hair loss). They also face an increased risk of developing the following conditions at the site of the original injury peripheral neuropathy, squamous cell carcinoma of the skin (at the site of the scar from a cold injury), arthritis or other bone abnormalities (osteoporosis, subarticular punched out lesions). Service connection for these residuals may be in order if they arise in the area of a cold injury incurred during military service unless an intercurrent nonservice-connected cause is determined. The fact that a nonservice-connected systemic disease that could produce similar findings is present, or that other areas of the body not affected by cold injury have similar findings, does not necessarily preclude service connection for such conditions in the cold injured areas. When considering the possibility of intercurrent cause, reasonable doubt, as defined in 38 CFR 3.102, will always be resolved in the veteran's favor.

  • The Chosin Reservoir Campaign was conducted during the Korean War from October 1950 until December 1950 in temperatures of -20F or lower. Many participants in this campaign suffered from frostbite for which they received no treatment. Consequently there may be no service treatment records to directly support their claims for frostbite. If the veteran's participation in the Chosin Reservoir Campaign is confirmed, it would be reasonable to concede exposure to extreme cold, under the provisions of 38 U.S.C. 1154(a). Provided there are no other circumstances to which this disability may be attributed, service connection under the provisions of 38 CFR 3.303(a) and 38 CFR 3.304(d) must be considered if the veteran has a disability which is diagnosed as a residual of cold injury.

• If there is amputation or loss of use of an extremity, consider entitlement to special monthly compensation under 38 CFR 3.350 [Special monthly compensation ratings].  Code: 7122.

• If a Veteran is a former prisoner of war, this disease shall be service connected if manifest to a degree of disability of 10% or more at any time after discharge or release from active military, naval, or air service even though there is no record of such disease during service, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR §3.309 (c) Disease subject to presumptive service connection].

Notes

• Separately evaluate amputations of fingers or toes, and complications such as squamous cell carcinoma at the site of a cold injury scar or peripheral neuropathy, under other diagnostic codes. Separately evaluate other disabilities diagnosed as the residual effects of cold injury, such as Raynaud's syndrome (which is otherwise known as secondary Raynaud's phenomenon), muscle atrophy, etc., unless they are used to support an evaluation under diagnostic code 7122.

• Evaluate each affected part (e.g., hand, foot, ear, nose) separately and combine the ratings in accordance with 38 CFR 4.25 and 38 CFR 4.26.

• The rating criteria for cardiovascular conditions underwent full-scale revision effective on November 14, 2021 and January 12, 1999.  A regulatory change was effective August 13, 1998, updated criteria for cold injury residuals under 38 CFR 4.104, DC 7122.  The changes are not considered liberalizing and should not be used as the basis for reduction unless the disability has actually improved.