(4) Soldiers will be referred to an MEB for recurrent cold injury, recurrent or persistent cold sensitivity despite the
P–2 profile, vascular or neuropathic symptoms, or disability due to tissue lost from cold injury.
b. Trench foot (nonfreezing cold injury).
(1) The definition of trench foot is the consequence of prolonged cold immersion of an extremity. It is manifested
by maceration of tissue and neurovascular injury.
(2) Soldiers with residual symptoms or significant tissue loss after healing will be referred to an MEB.
c. Accidental hypothermia.
(1) The definition of accidental hypothermia is clinically significant depression of body temperature due to environ-
mental cold exposure.
(2) Soldiers with significant symptoms of cold intolerance or a recurrence of hypothermia after an episode of
accidental hypothermia will be referred to an MEB.
Table 3–1
Methods of assessing cardiovascular disability
Class New York Heart Association Canadian Cardiovascular Soci- Specific activity scale (Goldstein New York Heart Association
Functional Classification ety Functional Classification et al: Circulation 64:1227, 1981) Functional Classification (Re-
vised)
I. Patient with cardiac disease
but without resulting limita-
tions of physical activity. Or-
dinary physical activity does
not cause undue fatigue,
palpitations, dyspnea, or an-
ginal pain.
Ordinary physical activity,
such as walking and climb-
ing, stairs, does not cause
angina. Angina with strenu-
ous or rapid or prolonged
exertion at work or recrea-
tion.
Patients can perform to
completion any activity re-
quiring 7 metabolic equiva-
lents: for example, can carry
24 lbs up eight steps, carry
objects that weigh 80 lbs,
do outdoor work. (shovel
snow, spade soil), do
recreational activities (ski-
ing, basketball, handball,
jog, and walk 5 mph).
Cardiac status uncom-
promised.
II. Patients with cardiac dis-
ease resulting in slight limi-
tation of physical activity.
They are comfortable at
rest. Ordinary physical ac-
tivity results in fatigue, pal-
pitation, dyspnea, or anginal
pain
Slight limitations of ordinary
activity. Walking or climbing
stairs rapidly, walking uphill,
walking or stair climbing af-
ter meals, in cold, in wind,
or when under emotional
stress, or only during the
few hours after awakening.
Walking more than 2 blocks
on the level and climbing
more than one flight of ordi-
nary stairs at a normal pace
and in normal conditions.
Patient can perform to com-
pletion any activity requiring
≥5 metabolic equivalents,
but cannot and does not
perform to completion activi-
ties requiring metabolic
equivalents: for example,
have sexual intercourse
without stopping, garden,
rake, weed, roller skate,
dance fox trot, walk at 4
mph on level ground.
Slightly compromised.
III. Patients with cardiac dis-
ease resulting in marked
limitation of physical activity.
They are comfortable at
rest. Less than ordinary
physical activity causes fa-
tigue, palpitation, dyspnea,
or anginal pain.
Marked limitation of ordinary
physical activity. Walking
one to two blocks on the
level and climbing more
than one flight in normal
conditions.
Patient can perform to com-
pletion any activity requiring
≥2 metabolic equivalents
but cannot and does not
perform to completion activi-
ties requiring ≥5 metabolic
equivalents: for example,
shower without stopping,
strip and make bed, clean
windows, walk 2.5 mph,
bowl, play golf, dress with-
out stopping.
Moderately compromised.
IV. Patient with cardiac disease
resulting in inability to carry
on any physical activity
without discomfort. Symp-
toms of cardiac insufficiency
or of the anginal syndrome
may be present even at
rest. If any physical activity
is undertaken, discomfort is
increased.
Inability to carry on any
physical activity without dis-
comfort—anginal syndrome
may be present at rest.
Patient cannot or does not
perform to completion activi-
ties requiring ≥2 metabolic
equivalents. Cannot carry
activities listed above (spec-
ify activity scale, Class III).
Severely compromised.
New York Heart Association Therapeutic Classification
38 AR 40–501 • 14 December 2007