ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS IN THE CASE OF: BOARD DATE: 1 May 2020 DOCKET NUMBER: AR20190001861 APPLICANT REQUESTS: award of the Purple Heart. APPLICANT'S SUPPORTING DOCUMENTS CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of Military Record under the Provisions of Title 10, U.S. Code, Section 1552) * Letter, Applicant, undated * two Air Force Forms 3899 (Aeromedical Evacuation Patient Record), dated 19 and 26 October 2004 * Letter, U.S. Army Human Resources Command, dated 21 June 2017 REFERENCES: 1. Army Regulation 600-8-22 (Military Awards) provides that the Purple Heart is an entitlement and differs from all other awards. a. The Purple Heart is awarded to members of the Armed Forces of the United States who, while serving under competent authority in any capacity with one of the U.S. Armed Services after 5 April 1917, have been wounded, were killed, or who have died or may hereafter die of wounds received under any of the following circumstances: * in any action against an enemy of the United States * in any action with an opposing armed force of a foreign country in which the Armed Forces of the United States are or have been engaged * while serving with friendly foreign forces engaged in an armed conflict against an opposing armed force in which the United States is not a belligerent party * as the result of an act of any such enemy of opposing Armed Forces * as the result of an act of any hostile foreign force * after 28 March 1973, as a result of an international terrorist attack against the United States or a foreign nation friendly to the United States, recognized as such an attack by the Secretary of the Army, or jointly by the Secretaries of the separate Armed Services concerned if persons from more than one service are wounded in the attack * after 28 March 1973, as a result of military operations while serving outside the territory of the United States as part of a peacekeeping force * service members who are killed or wounded in action by friendly fire * a former prisoner of war who was wounded before 25 April 1962 while held as a prisoner of war (or while being taken captive) * service members killed or wounded in attacks by foreign terrorist organizations b. A wound is defined as an injury to any part of the body from an outside force or agent sustained under one or more of the conditions listed below. A physical lesion is not required. However, the wound for which the award is made must have required treatment, not merely examination, by a medical officer. Additionally, treatment of the wound will be documented in the service member's medical and/or health record. Award of the Purple Heart may be made for wounds treated by a medical professional other than a medical officer provided a medical officer includes a statement in the service member's medical record that the extent of the wounds was such that they would have required treatment by a medical officer if one had been available to treat them. c. The key issue commanders must take into consideration when contemplating an award of this decoration is the degree to which the enemy caused the injury. The fact that the proposed recipient was participating in direct or indirect combat operations is a necessary prerequisite, but is not sole justification for award. d. Examples of enemy-related injuries which clearly justify award of the Purple Heart are as follows: * injury caused by enemy bullet, shrapnel, or other projectile created by enemy action * injury caused by enemy-placed trap or mine * injury caused by enemy-released chemical, biological, or nuclear agent * injury caused by vehicle or aircraft accident resulting from enemy fire * concussion injuries caused as a result of enemy-generated explosions * mild traumatic brain injury (TBI) or concussion severe enough to cause either loss of consciousness or restriction from full duty due to persistent signs, symptoms, or clinical finding, or impaired brain function for a period greater than 48 hours from the time of the concussive incident e. Examples of injuries or wounds which clearly do not justify award of the Purple Heart are as follows: * frostbite (excluding severe frostbite requiring hospitalization from 7 December 1941 to 22 August 1951) * trench foot or immersion foot * heat stroke * food poisoning not caused by enemy agents * chemical, biological, or nuclear agents not released by the enemy * battle fatigue * disease not directly caused by enemy agents * accidents, to include explosive, aircraft, vehicular, and other accidental wounding not related to or caused by enemy action * self-inflicted wounds, except when in the heat of battle and not involving gross negligence * post-traumatic stress disorder * airborne (for example, parachute/jump) injuries not caused by enemy action * hearing loss and tinnitus (for example, ringing in the ears) * mild TBI or concussions that do not either result in loss of consciousness or restriction from full duty for a period greater than 48 hours due to persistent signs, symptoms, or physical finding of impaired brain function * abrasions and lacerations (unless of a severity to be incapacitating) * bruises (unless caused by direct impact of the enemy weapon and severe enough to require treatment by a medical officer) * soft tissue injuries (for example, ligament, tendon, or muscle strains, sprains, and so forth) * first degree burns f. Any member of the Army who believes that he or she is eligible for award of the Purple Heart, but through unusual circumstances no award was made, may submit an application through the member's chain of command to the Commander, U.S. Army Human Resources Command (AHRC-PDP-A). If the requestor has separated from the military, the application may be mailed directly to the Commander, U.S. Army Human Resources Command (AHRC-PDP-A). The application will include the following documentation pertaining to the wound and inflicting force: * DA Form 4187 (Personnel Action) (for currently serving members) * chain of command endorsement (through the first general officer in the Soldier's current chain of command for currently serving members) * deployment orders * DA Form 4037 (Officer Record Brief)/Enlisted Record Brief/DA Form 2-1 (Personnel Qualification Record – Part II) * one-page narrative describing the qualifying incident and the conditions under which the member was injured or wounded * statements from at least two individuals, other than the proposed recipient, who were personally present, observed the incident, and have direct knowledge of the event – alternatively, other official documentation may be used to corroborate the narrative * Casualty Report (if available) * Standard Form 600 (Medical Record – Chronological Record of Medical Care) * DD Form 214 (Certificate of Release or Discharge from Active Duty) (if applicable) 2. Military Personnel Message 11-125, dated 29 April 2011, subject: Army Directive 2011-07 (Awarding the Purple Heart), provides clarifying guidance to ensure the uniform application of advancements in medical knowledge and treatment protocols when considering recommendations for award of the Purple Heart for concussions, including mild traumatic brain and concussive injuries that do not result in a loss of consciousness. This message does not change the standards for award of the Purple Heart for concussion injuries. This policy is retroactive to 11 September 2001 in compliance with Under Secretary of Defense for Personnel and Readiness memorandum, dated 25 April 2011, subject: Department of Defense Baseline Standard for Award of the Purple Heart Medal for Mild TBIs and Concussion Injuries Not Resulting in a Loss of Consciousness. All requests that are not processed within theater must be processed through the peacetime chain of command. a. When recommending and considering award of the Purple Heart, the chain of command will ensure the criteria in Army Regulation 600-8-22 are met and that both diagnostic and treatment factors are present and documented in the Soldier's medical record by a medical officer. b. The following non-exclusive list provides examples of signs, symptoms, or medical conditions documented by a medical officer or medical professional that meet the standard for award of the Purple Heart: * diagnosis of concussion or mild TBI * any period of loss or a decreased level of consciousness * any loss of memory for events immediately before or after the injury * neurological deficits (weakness, loss of balance, change in vision, praxis (i.e., difficulty with coordinating movements), headaches, nausea, difficulty with understanding or expressing words, sensitivity to light, etc.) that may or may not be transient * intracranial lesion (positive computerized axial tomography or magnetic resonance imaging scan) c. The following non-exclusive list provides examples of medical treatment for concussion that meet the standard of treatment necessary for award of the Purple Heart: * limitation of duty following the incident (limited duty, quarters, etc.) * pain medication such as acetaminophen, aspirin, ibuprofen, etc., to treat injury, such as headache * referral to neurologist or neuropsychologist to treat the injury * rehabilitation (such as occupational therapy, physical therapy, etc.) to treat injury d. Combat theater and unit command policies mandating rest periods or "down time" following incidents do not constitute qualifying treatment for concussion injuries. To qualify as medical treatment, this rest period must have been directed by a medical officer or medical professional for the individual after diagnosis of an injury as indicated above. FACTS: 1. The applicant states: a. He served in in Iraq from 3 February 2004 until he was medically evacuated on 13 October 2004 for a TBI he received as a result of the impact of a 122-millimeter rocket attack. He was medically evacuated and treated at the Landstuhl Regional Medical Center in Germany for 72 hours. Then he was medically evacuated to Walter Reed National Military Medical Center in Washington, DC, for further treatment. b. At the time of his injury, a TBI was not considered a wound. TBI was added to the eligible list of wounds in Military Personnel Message 11-125. This directive is retroactive to 11 September 2001. c. He was exposed to blasts from indirect fire on two occasions because he was within the blast wave. The last explosion occurred on 11 October 2004 when he was headed to the dining facility on Logistical Support Area Anaconda which is near Balad, Iraq. He heard a rocket overhead and he reacted to the indirect fire by dropping to the ground. The impact was approximately 100-150 yards to his right. He heard the explosion and felt the blast wave. He was face down to the ground when the impact occurred. He was hit with rocks, debris, and the blast wave. Shrapnel was found in a tree trunk 10 yards from him. If he had not reacted to the indirect fire; he would have been more seriously injured or dead. He felt like he had been hit by a concrete block. He checked himself for bleeding and found no blood or spinal fluid in his ears. There was no one with him at the time of the incident. It was common to walk around Logistical Support Area Anaconda without another person. d. He had problems speaking and using his left hand. He still has massive headaches. He was treated with Depakote and told he had a concussion. e. He was told TBIs became eligible injuries for award of the Purple Heart in 2008. 2. The applicant provided his Air Force Forms 3899 showing: a. On 19 October 2004, he was treated at the Landstuhl Regional Center for diagnoses of left upper extremity tremors and concussion. The treating physician noted a 30-day history of left upper extremity tremors and loss of fine motor control, slurred speech or stuttering, and concussion. He was taking Depakote (used to treat seizure disorders, certain psychiatric conditions, and to prevent migraine headaches) for a history of cluster and migraine headaches. He was prescribed Valium (used to treat anxiety disorders, alcohol withdrawal symptoms, or muscle spasms), Lotrel (used to treat high blood pressure), and Depakote. b. On 26 October 2004, he was treated at the Walter Reed National Military Medical Center for diagnoses of anxiety disorder (not otherwise specified), hypertension, migraine, and concussion. The treating physician noted he presented with an anxiety disorder with involuntary movement disorder and concussion. He was prescribed Zoloft (used to treat depression, panic attacks, obsessive compulsive disorder, post-traumatic stress disorder, and social anxiety disorder), Depakote, and Lotrel. 3. He was honorably discharged from the Indiana Army National Guard in the rank/grade of staff sergeant/E-6 on 1 January 2007 and transferred to the U.S. Army Reserve Control Group (Retired Reserve). His National Guard Bureau (NGB) Form 22 (Report of Separation and Record of Service) and NGB Form 22A (Correction to NGB Form 22) show he was awarded or authorized the: * Army Service Ribbon * National Defense Service Medal (2nd Award) * Armed Forces Reserve Medal with "M" Device * Global War on Terrorism Expeditionary Medal * Combat Action Badge * Iraq Campaign Medal * Global War on Terrorism Service Medal * Army Achievement Medal * Armed Forces Reserve Medal (2nd Award) * Noncommissioned Officer Professional Development Ribbon * Army Commendation Medal * Army Reserve Components Achievement Medal (5th Award) * Indiana Military Volunteer Emblem * Indiana Emergency Service Ribbon * Indiana Long Service Medal (15-Year) * Indiana Overseas Service Ribbon * Overseas Service Ribbon * Meritorious Service Medal * Expert Infantryman Badge * Parachutist Badge 4. On 21 June 2017, the U.S. Army Human Resources Command disapproved his request for award of the Purple Heart for injuries received while deployed in support of Operation Iraqi Freedom. The Chief, Soldier Programs and Services Division, stated that after a thorough review of the information provided and consultation with the U.S. Army Human Resources Command Surgeon's Office, an award of the Purple Heart for this event does not meet the statutory guidance outlined in Army Regulation 600-8-22, paragraph 2-8e. The lack of supporting medical documentation at or near the date of enemy action reflecting a diagnosis or indication of a qualifying injury makes it impossible to connect an injury to the incident. BOARD DISCUSSION: 1. After reviewing the application and all supporting documents, the Board found that relief was not warranted. Per the regulatory guidance on awarding the Purple Heart, the applicant must provide or have in his service records substantiating evidence to verify that he was injured, the wound was the result of hostile action, the wound must have required treatment by medical personnel, and the medical treatment must have been made a matter of official record. 2. In events involving TBI and other similar injuries, the applicant’s record must show that the brain injury or concussion severe enough to cause either loss of consciousness or restriction from full duty due to persistent signs, symptoms, or clinical finding, or impaired brain function for a period greater than 48 hours from the time of the concussive incident. The Board found insufficient medical evidence to meet the regulatory standard for the Purple Heart and thus recommended denying the request. BOARD VOTE: Mbr 1 Mbr 2 Mbr 3 : : : GRANT FULL RELIEF : : : GRANT PARTIAL RELIEF : : : GRANT FORMAL HEARING :XXX :XXX :XXX DENY APPLICATION BOARD DETERMINATION/RECOMMENDATION: The evidence presented does not demonstrate the existence of a probable error or injustice. Therefore, the Board determined the overall merits of this case are insufficient as a basis for correction of the records of the individual concerned. I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case. ADMINISTRATIVE NOTE(S): The applicant states he suffered a concussive injury in Iraq on 11 October 2004. He provided no medical documentation showing examination and treatment prior to 19 October 2001 and no witness statements. //NOTHING FOLLOWS// ABCMR Record of Proceedings (continued) AR20190001861 8 1