IN THE CASE OF: BOARD DATE: 18 January 2022 DOCKET NUMBER: AR20210012475 APPLICANT REQUESTS: entitlement to the Purple Heart (PH). APPLICANT'S SUPPORTING DOCUMENTS CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of Military Record) * Letter dated 19 February 2021 * 2 Self-Authored Statements * DD Form 689 (Individual Sick Slip) * DA Form 2173 (Statement of Medical Examination and Duty Status) * Orders 04-208-00435 dated 26 July 2004 * DD Form 2697 (Back) (Report of Medical Assessment) * 2 DD Forms 214 (Certificate of Release or Discharge from Active Duty) * Orders 08-161-00349 dated 9 June 2008 * Military Personnel (MILPER) Message Number 11-125, issued 29 April 2011 FACTS: 1. The applicant states, in effect: a. On 6 October 2005, he was a .50 caliber gunner on a High Mobility Multipurpose Wheeled Vehicle (HMMV) turret, conducting combat/security patrol operations along Route Dover, outside Logistic Support Area (LSA) Anaconda. While standing in the gunner's turret, scanning for signs of possible improvised explosive devices (IEDs) or other anti- coalition/insurgent activities, an IED exploded/detonated about 10 meters from the front- right passenger side of his HMMV. He remembers seeing the ground rise before the strong wave of the explosion hit him so hard that he blacked out momentarily and found himself on the floor of the gunner's turret. At the time, he couldn't hear a thing except for the ringing in his ears, and suffered with a severe chest pain, drowsiness and disorientation. After what felt like forever, he finally snapped out of his shock and tried to get his bearing to prepare himself for an onslaught, which fortunately did not come. It was during this time that his adrenaline had peaked as he gained focus to respond to any further threat. With his adrenaline reaching its peak, his physical pain (including his chest pain), severe headache, and ringing in his ears were the last things in his mind, for a moment he denied anything was wrong with him. b. Soon after the IED blast, they gathered themselves and conducted accountability. After they had secured the area and his adrenaline cooled down, he started to feel a massive pain in his chest, drowsiness, severe headache, as well as pains throughout his body. At this point, he was immediately rushed to the Medical Treatment Facility in LSA Anaconda for evaluation and treatment. He was provided either lbuprofen or Tylenol for the pain and headaches. He would not be allowed to go on combat/security patrol missions until he fully recovered and he was told to come back immediately if his concussion symptoms worsened within the next 24 hours. He was also restless the whole time and he was unable to go to sleep. After his 24 hours of no duty was completed, he was put back on the line due to his willingness to continue the mission with his brother-in-arms. The severe headaches, chest pains, and pains throughout his body continued for the next few weeks. He did not report to sick-call because he did not want to be taken off the line from doing missions outside the wire. He dealt with the pain by taking large doses of Motrin and Tylenol. 2. Having 4 months and 13 days of total prior active service, the applicant entered active duty on 16 August 2004, as an infantryman in the U.S. Army Reserve. Evidence shows he served in Iraq from 26 January 2005 to 28 December 2005. On 4 February 2006, he was honorably released from active duty (REFRAD) upon completion of his required active service. The DD Form 214 he was issued upon his release shows he was awarded or authorized the: * Army Commendation Medal * Army Good Conduct Medal * Army Reserve Components Achievement Medal * National Defense Service Medal * Global War on Terrorism Service Medal * Army Service Ribbon * Overseas Service Ribbon * Armed Forces Reserve Medal with "M" Device * Combat Infantryman Badge * Iraq Campaign Medal 3. Evidence shows he further served in Kuwait/Iraq from 3 November 2008 to 15 August 2009, in support of Operation Iraqi Freedom. On 3 November 2009, he was honorably REFRAD upon completion of his required active service. The DD Form 214 he was issued upon his release shows he was awarded or authorized the: * Iraq Campaign Medal with 2 bronze service stars * Army Commendation Medal * Army Achievement Medal * Army Good Conduct Medal * Army Reserve Components Achievement Medal * National Defense Service Medal * Global War on Terrorism Expeditionary Medal * Global War on Terrorism Service Medal * Army Service Ribbon * Overseas Service Ribbon (2nd Award) * Armed Forces Reserve Medal with 10 Year Device-Bronze * Combat Infantryman Badge 4. On 19 February 2021, the U.S. Army Human Resources Command (AHRC) disapproved his request for entitlement to the PH. a. Based upon review of his forwarded documentation as well as consultation with the AHRC Office of the Surgeon General, they determined the incident in question did not meet the criteria for entitlement to the PH. b. They acknowledged receipt of documentation reflecting his initial examination after an IED blast on 6 October 2005; his assigned quarters for 24 hours and prescribed acetaminophen as needed; as well as a request to return immediately if his symptoms of hearing loss and headache worsened. Following the exam, there was no official military documentation stating that he returned to receive further treatment until his redeployment. c. They noted they could not utilize any post-deployment diagnosis as the primary means to justify entitlement to the PH. Further, in accordance with Army Regulation 600-8-22 (Military Awards), paragraph 2-8, hearing loss (i.e. ruptured tympanic membrane) does not constitute a qualifying injury for entitlement to the PH. 5. The applicant provides a/an: a. Letter dated 2 March 2021, in which he claims according to his provided documents and the guidance set forth in Army Regulation 600-8-22 and Army Directive 2011-07 (Executive Order 11016), he meets the diagnostic and treatment factors/criteria for eligibility for the PH. His 24-hour rest period was directed/mandated by a medical officer and the prescription of acetaminophen were treatments for a diagnosed injury immediately after the IED incident. b. DD Form 688 dated 6 October 2005, which notes he was seen for an IED check- up. The remarks section appears to show, "IED Blast, Hearing Loss, No Mission x 24 hours, Hearing Test 20061008." c. DA Form 2173 dated 6 October 2005, which notes, in effect, while in Balad, Iraq on 6 October 2005, he was in a mounted vehicle when an IED detonated 10-20 meters from his vehicle. The applicant initially received no injuries, but after completion of the mission, he complained of pain in numerous parts of his body. He was taken directly to the medical treatment facility for a complete medical exam where he complained of hearing loss, headache and discomfort throughout his body. d. DD Form 2697 (Back), dated 4 January 2006, in which the health care provider commented the applicant reported possible hearing loss and a concussion with no residual headaches. He denied any breathing difficulties; however, his vision had worsened during the deployment. Audiology and ophthalmology consults were placed. e. MILPER Message Number 11-125 issued 29 April 2011, in which it appears the applicant highlighted various passages which he believes supports his entitlement to the PH. 6. Army Regulation 600-8-22 contains the regulatory guidance pertaining to entitlement to the PH and requires all elements of the award criteria to be met. There must be proof a wound was incurred as a result of enemy action, that the wound required treatment by medical personnel, and that the medical personnel made such treatment a matter of official record. Additionally, when based on a traumatic brain injury (TBI), the regulation stipulates the TBI or concussion must have been severe enough to cause a LOC; or restriction from full duty due to persistent signs, symptoms, or clinical findings; or impaired brain functions for a period greater than 48 hours from the time of the concussive incident. BOARD DISCUSSION: 1. After reviewing the application, all supporting documents, and the evidence found within the military record, the Board found that relief was not warranted. The applicant’s contentions, the military record, and regulatory guidance were carefully considered. Board members noted that regulator guidance states, in order to be awarded the PH based on a traumatic brain injury (TBI), the regulation stipulates the TBI or concussion must have been severe enough to cause a LOC; or restriction from full duty due to persistent signs, symptoms, or clinical findings; or impaired brain functions for a period greater than 48 hours from the time of the concussive incident. Board members acknowledged the documentation reflecting his initial examination after an IED blast on 6 October 2005; however, he was assigned quarters for 24 hours and prescribed acetaminophen as needed; as well as a request to return immediately if his symptoms of hearing loss and headache worsened. Following the exam, there was no official military documentation stating that he returned to receive further treatment until his redeployment. Board members found insufficient evidence he met the criteria for award of the PH. BOARD VOTE: Mbr 1 Mbr 2 Mbr 3 : : : GRANT FULL RELIEF : : : GRANT PARTIAL RELIEF : : : GRANT FORMAL HEARING XX: XX: XX: 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. REFERENCES: 1. Army Regulation 600-8-22 prescribes Army policy, criteria, and administrative instructions concerning individual and unit military awards. a. The PH is awarded for a wound sustained while in action against an enemy or as a result of hostile action. Substantiating evidence must be provided to verify that 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. 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 above. 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 PH 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. When contemplating an award of the PH, the key issue that commanders must take into consideration 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 the sole justification for award. d. Examples of enemy-related injuries that clearly justify award of the PH include concussion injuries caused as a result of enemy-generated explosions resulting in a mild 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 that clearly do not justify award of the PH include post-traumatic stress disorders, hearing loss and tinnitus, 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. f. When recommending and considering award of the PH for a mild TBI or concussion, the chain of command will ensure that both diagnostic and treatment factors are present and documented in the Soldier's medical record by a medical officer. 2. Army Directive 2011-07 (Awarding the PH), dated 18 March 2011, provides clarifying guidance to ensure the uniform application of advancements in medical knowledge and treatment protocols when considering recommendations for award of the PH for concussions (including mild TBI and concussive injuries that do not result in a LOC). The directive also revised Army Regulation 600-8-22 to reflect the clarifying guidance. a. Approval of the PH requires the following factors among others outlined in Department of Defense Manual 1348.33 (Manual of Military Decorations and Awards), Volume 3, paragraph 5c: wound, injury or death must have been the result of an enemy or hostile act, international terrorist attack, or friendly fire; and the wound for which the award is made must have required treatment, not merely examination, by a medical officer. Additionally, treatment of the wound shall be documented in the Soldier's medical record. b. Award of the PH may be made for wounds treated by a medical professional other than a medical officer provided a medical officer includes a statement in the Soldier'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. A medical officer is defined as a physician with officer rank. The following are medical officers: an officer of the Medical Corps of the Army, an officer of the Medical Corps of the Navy, or an officer in the Air Force designated as a medical officer in accordance with Title 10, United States Code, Section 101. d. A medical professional is defined as a civilian physician or a physician extender. Physician extenders include nurse practitioners, physician assistants and other medical professionals qualified to provide independent treatment (for example, independent duty corpsmen and Special Forces medics). Basic corpsmen and medics (such as combat medics) are not physician extenders. e. When recommending and considering award of the PH for concussion injuries, the chain of command will ensure that the criteria are met and that both diagnostic and treatment factors are present and documented in the Soldier's medical record by a medical officer. f. The following nonexclusive 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 PH: (1) Diagnosis of concussion or mild TBI; (2) Any period of loss or a decreased level of consciousness; (3) Any loss of memory of events immediately before or after the injury; (4) Neurological deficits (weakness, loss of balance, change in vision, praxis (that is, difficulty with coordinating movements), headaches, nausea, difficulty with understanding or expressing words, sensitivity to light, etc.) that may or may not be transient; and (5) Intracranial lesion (positive computerized axial tomography) or magnetic resonance imaging scan. g. The following nonexclusive list provides examples of medical treatment for concussion that meet the standard of treatment necessary for award of the PH: (1) Limitation of duty following the incident (limited duty, quarters, etc.); (2) Pain medication, such as acetaminophen, aspirin, ibuprofen, etc., to treat the injury; (3) Referral to a neurologist or neuropsychologist to treat the injury; and (4) Rehabilitation (such as occupational therapy, physical therapy, etc.) to treat the injury. h. Combat theater and unit command policies mandating rest periods or downtime following incidents do not constitute qualifying treatment for concussion injuries. To qualify as medical treatment, a medical officer or medical professional must have directed the rest period for the individual after diagnosis of an injury. 3. Army Regulation 15-185 (ABCMR) prescribes the policies and procedures for correction of military records by the Secretary of the Army, acting through the ABCMR. The ABCMR considers individual applications that are properly brought before it. The ABCMR will decide cases on the evidence of record. It is not an investigative body. The ABCMR begins its consideration of each case with the presumption of administrative regularity. The applicant has the burden of proving an error or injustice by a preponderance of the evidence. //NOTHING FOLLOWS// ABCMR Record of Proceedings (cont) AR20210012475 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1