How to file a VA cold injury residuals claim — frostbite, immersion foot and non-freezing cold injury under DC 7122, the former-POW presumption, and evidence
Cold injuries — frostbite, non-freezing cold injury, immersion foot (formerly trench foot) and hypothermia — can leave lifelong residuals in the exposed hands, feet, ears and face: pain, numbness, cold sensitivity, nail and color changes, impaired sensation, abnormal sweating, X-ray changes, tissue loss, ulceration and nerve injury. VA rates them under 38 CFR 4.104, diagnostic code 7122, separately for each affected part: 10% for arthralgia or other pain, numbness or cold sensitivity; 20% with one of the listed findings added; 30% with two or more. Amputations, peripheral neuropathy, squamous cell carcinoma at a cold-injury scar and other diagnosed residuals are rated under their own codes. VA Public Health names the Battle of the Bulge, the Chosin Reservoir campaign (temperatures to 50 below) and Afghanistan as well as training as settings for cold injury. There is no general cold-injury presumption; VA decides these claims case by case, except that a former prisoner of war interned in conditions consistent with frostbite is presumed service-connected for organic residuals of frostbite under 38 CFR 3.309(c).
What you'll need
- VA Form 21-526EZ
- Service records placing you in the cold exposure (unit, dates, location, POW status) and any treatment for frostbite, trench foot or hypothermia
- Current medical findings: sensation testing, nail and skin changes, color changes, X-rays, nerve conduction studies, vascular studies
- Lay statements from fellow service members or family about the exposure and symptoms since
- A free accredited representative (CVSO or VSO)
Step-by-step
Step 1: Document the exposure and the injury
Gather what shows you were in the cold: unit records and morning reports, orders, awards and campaign credit (Korean War service is June 27, 1950 – January 31, 1955; the Chosin Reservoir campaign ran October–December 1950; the Battle of the Bulge December 1944 – January 1945), POW records, or training records for cold-weather exercises. Treatment at the time helps but is often missing; a statement describing the exposure, the symptoms you had then (blistering, blackened toes, numb feet for weeks) and the symptoms since, with statements from others who were there, is acceptable evidence. Missing service records can be requested from the National Personnel Records Center, and VA must help obtain them.
Reference: https://www.publichealth.va.gov/exposures/cold-injuries/index.asp
Step 2: Former POWs — use the presumption
Under 38 CFR 3.309(c)(1), any former prisoner of war is presumed service-connected for organic residuals of frostbite if interned in climatic conditions consistent with frostbite, as well as for post-traumatic osteoarthritis, atherosclerotic heart disease, hypertensive vascular disease, stroke, psychosis, anxiety states and dysthymic disorder, when the condition is 10% disabling at any time after service. Peripheral neuropathy (not from an infectious cause), nutritional deficiencies, irritable bowel syndrome, peptic ulcer disease and cirrhosis are added for POWs interned 30 days or more (3.309(c)(2)). VA verifies POW status from service records.
Step 3: Get the current residuals documented
DC 7122 rates on specific findings, so ask your clinician to record, for each affected part: pain, numbness or cold sensitivity; tissue loss; nail abnormalities; color changes; locally impaired sensation; hyperhidrosis or anhidrosis; X-ray abnormalities (osteoporosis, subarticular punched-out lesions or osteoarthritis); atrophy or fibrosis of muscle; flexion or extension deformity of distal joints; loss of volar fat pads in fingers or toes; avascular necrosis; chronic ulceration; carpal or tarsal tunnel syndrome. Photographs of color changes during cold exposure and a note of what you cannot do in cold weather are useful because the exam room is warm.
Step 4: File, naming each affected part
On VA Form 21-526EZ list "residuals of cold injury" for each part — right foot, left foot, right hand, left hand, ears, nose — because each is rated separately and combined under 38 CFR 4.25 with the bilateral factor (4.26) for paired hands or feet. Also list any diagnosed complications — peripheral neuropathy, amputated toes or fingers, skin cancer at a scar, Raynaud's phenomenon — as separate conditions. File online, by mail to the Claims Intake Center (PO Box 4444, Janesville, WI 53547-4444), in person or through a free accredited representative.
Reference: https://www.va.gov/disability/file-disability-claim-form-21-526ez/
Step 5: The rating under DC 7122
For each affected part: 10% — arthralgia or other pain, numbness, or cold sensitivity; 20% — those symptoms plus one of: tissue loss, nail abnormalities, color changes, locally impaired sensation, hyperhidrosis, anhidrosis, X-ray abnormalities, muscle atrophy or fibrosis, deformity of distal joints, volar fat pad loss, avascular necrosis, chronic ulceration, or carpal or tarsal tunnel syndrome; 30% — those symptoms plus two or more of the listed findings. Note (1) requires amputations and complications such as squamous cell carcinoma at the scar or peripheral neuropathy to be rated separately under other codes, and other disabilities diagnosed as residuals of the cold injury (for example Raynaud's phenomenon or arthritis) are rated under their own codes unless they are used to support the DC 7122 rating.
Critical tips
- VA's environmental health coordinator at your medical center can arrange an evaluation of cold-injury health problems; ask for one if you are enrolled in VA care.
- Survivors: if a veteran's death certificate lists a condition that was service-connected or that medical evidence ties to the cold injury (amputation complications, vascular disease), DIC may be payable — see the survivor claims guide.
- A cold-injury rating for a foot does not preclude separate ratings for a service-connected ankle or knee condition, as long as the same symptom is not rated twice (4.14).
- A county veterans service officer can request unit records and file the claim for free: warriorsfund.org/find-cvso.
- In crisis: dial 988 then press 1, or text 838255.