IN THE CASE OF: BOARD DATE: 11 May 2023 DOCKET NUMBER: AR20220007604 APPLICANT REQUESTS: entitlement to the Purple Heart. APPLICANT'S SUPPORTING DOCUMENT(S) CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of Military Record) * DD Form 1610 (Request and Authorization for Temporary Duty Travel of Department of Defense Personnel, 14 March 2018 * 2-page Per Diem and Reimbursable Expenses, 14 March 2018 - 4 September 2018 * 3 pages of a Standard Form (SF) 600 (Chronological Record of Medical Care), 11 August 2018 * 2 DA Forms 2823 (Sworn Statement), and Master Sergeant (MSG) , 21 August 2018 * Statement under oath, , undated * Memorandum for Record (MFR), Lieutenant Colonel (LTC) , 22 March 2021 * DA Form 4187 (Personnel Action), 6 April 2021 * MFR, applicant, 7 June 2021 * Memorandum, Army Human Resources Command (AHRC), 9 July 2021 FACTS: 1. The applicant did not file within the 3-year time frame provided in Title 10, U.S. Code, section 1552(b); however, the Army Board for Correction of Military Records (ABCMR) conducted a substantive review of this case and determined it is in the interest of justice to excuse the applicant's failure to timely file. 2. The applicant states, in effect: a. He sustained and was treated for combat related injuries while serving on Operational Detachment-Alpha (OD-A) 1333 and he should be awarded the Purple Heart for injuries sustained regardless of who was able to treat him. The applicant is an 18D (Special Forces Medical Sergeant) and tried to self-treat while caring for 27 American service members and 40 partner force (Afghan National Army) members. The applicant was the only Special Forces Medic on the ground during a 10-day operation where they sustained 70 percent casualties and could not be evacuated because there would be no medical coverage to support ongoing operations. b. The applicant was danger close to a rocket propelled grenade (RPG) blast that rendered him confused and disoriented. During recovery and self-treatment, he was the sole remaining medic on the mission and continued to treat casualties until the Forward Surgical Team (FST) arrived. Once the FST arrived on the third day, he was treated by LTC and was diagnosed with a concussion and significant neck and back pain. After returning home from the combat theater, the applicant has undergone multiple treatments to include surgery to repair damage and injuries which were sustained during the mission. The applicant had clear signs of concussion and continued to fight and provide medical treatment to his teammates with no option of evacuation to a higher level of care. 3. The applicant is currently serving in the Regular Army in military occupational specialty 18D in the rank/grade of Sergeant First Class/E-7. His Enlisted Record Brief shows he served in Afghanistan for the period 14 March to 15 September 2018. 4. On 9 July 2021, the AHRC disapproved his request for entitlement to the Purple Heart for injuries received while deployed in support of Operation Freedom's Sentinel. The AHRC official stated, "after a thorough review of the information provided and consultation with the AHRC Office of the Surgeon General, the forwarded recommendation for award of the Purple Heart does not meet the statutory guidance outlined in Army Regulation 600-8-22 (Military Awards), paragraph 2-8g.c. To qualify for award of the Purple Heart the wound must have been of such severity that it required treatment, not merely examination, by a medical officer." 5. The applicant provides sworn statements from MSG and from , dated 21 August 2018. Both statements outline the events occurring on 12 August 2018, during a convoy in support of the district chief of Ghazni. The convoy parked outside the compound and half of the force dismounted and moved to make contact with the district chief. The lead middle truck was ambushed by the Taliban and was struck by an RPG. The applicant was standing outside the truck, within 25 meters of the blast. The applicant was knocked against the vehicle and moved to support the other trucks and get them turned around. The applicant was within the blast area of a second RPG hit. Within five minutes of leaving the compound, they came under another RPG attack resulting in three wounded. The applicant, knowing there were casualties in the vehicle, dismounted his truck and moved through the fire to provide aid to the members of his vehicle. The applicant helped with vehicle recovery exposing himself to enemy fire. The applicant subsequently exposed himself to sniper fire to provide medical aid to others. 6. An MFR from LTC dated 22 March 2021, in which he states the applicant was under his care from 12-18 August 2018, and he personally evaluated and treated the applicant for injuries sustained during combat. He states the applicant was initially injured by enemy RPG on 11 August 2018. Following the blast, he was immediately dazed with bilateral photopsia, with confusion, headaches, memory problems, irritability, and tinnitus. A second RPG blast on 12 August 2018, resulted in post injury left ear pain with intact tympanic membrane (TM). The applicant was tested and diagnosed with a concussion. The applicant sustained injuries during a third RPG attack during the mission which resulted in the stairs of the vehicle he was under breaking off and pinning him to the ground. He required extrication by his teammates and following the incident, he had significant neck and back pain which has impaired his ability to sit for extended periods of time and radiculopathy in his back and arms. 7. The applicant provides a sworn statement, dated 6 July 2021, in which he states, while on combat operations in Ghazni, Afghanistan from 11-21 August 2018, he was a gunner and dismount over a 10-day operation. On the second day of the operation, he was dismounted at a check point backing up an armored truck. An RPG hit 25 feet from where he was standing. He was knocked against his vehicle and fell to the ground. He was dazed and confused and had difficulty standing. He was the only medic in the convoy, so he was not able to seek immediate medical treatment. After the first RPG attack, they were trying to recover the disabled vehicle when a second RPG hit 50 feet from where he was standing. Later that night, they were ambushed again with the lead vehicle being hit three times by RPGs. He was in the second vehicle and dismounted to provide aid to the Soldiers of the lead vehicle. While hooking up the lead vehicle, the second RPG hit the truck. He was again knocked to the ground. While on the ground, the third RPG hit the side of the truck and the side shelf was blown off and landed on his head and back. He was pinned under the debris until teammates lifted it off his back. He was nauseous, with headache, memory loss and pain in his left ear. He was subsequently evaluated by LTC and diagnosed with a concussion, soft tissue damage to his neck and back and radiculopathy in his left arm and hand. He was unable to leave the team because he was the only medic. He received follow up care at Forward Operating Base (FOB) Dahlki upon return from mission. 8. An SF 600 signed on 11 August 2018 shows/states, the applicant was on patrol in Ghazni City when his patrol was ambushed. Applicant stated he was outside his vehicle when 2 RPGs struck within 25 meters or his location. Applicant stated that he had his "bell rung"' and felt dizzy following the event. Applicant stated that he didn't lose consciousness and remembers the event. Applicant stated that it was about five minutes between the RPG blasts and that he has headaches, pain and ringing in his left ear and pain in his neck for the past 24 hours. Positive for headache, nausea or vomiting, dizziness, and ringing in the left ear. Ears clear with no trauma to TM. Diagnosed as having sustained multiple blast injuries, concern for traumatic brain injury (TBI). Recommend avoidance of subsequent head trauma. Recommend formal TBI assessment in a safe location. Recommend advanced imaging in the future if indicated. Will monitor closely at this location if symptoms persist or worsen recommended evacuation to higher echelon of care. Discussed findings with the applicant and ground force commander. All questions were answered. 9. An SF 600 dated 15 August 2018, states, in effect, the applicant sustained explosive blasts from RPG attacks during convoy around FOB Ghazni. Presented to the Forward Surgical Team on 12 August 2018 with symptoms of headache, pain and ringing in the left ear. Reported decreased hearing in left ear. The applicant was evaluated multiple times over the course of his mission with persistent pain and ringing. Also has pain in his neck and back from being pinned under the metal stair of an RG-33 (Mine-Resistant Ambush Protected Vehicle). Applicant stated while trying to recover a disabled vehicle during a firefight, the applicant was under the stairs when the stairs gave way pinning his head and body to the ground. Complains of pain to neck and back as well as left arm. Positive for headache, memory problems, irritability, and ringing in the ears. TM normal with no bulging or perforation, no scleral icterus, neck supple, trachea midline. Diagnosed as having sustained multiple blast injuries, concern for TBI with persistent symptoms of hearing loss and ear pain. Applicant was tested and diagnosed with a concussion (TBI). Recommend avoidance of subsequent head trauma. Recommend formal TBI assessment and advanced imaging once in a safe location if indicated. Although external auditory canal was clear and TM intact, with persistent pain and diminished hearing. Symptoms improved over the course of the week. Applicant had own and was taking 800mg Motrin for pain in neck and upper back. If symptoms worsened, would have recommended evacuation to higher echelon of care. All questions were answered. 10. A DA Form 4187 signed dated by the applicant on 6 April 2021, recommended the applicant for award of the Purple Heart for wounds/injuries received in action caused directly by the enemy on 12 August 2018. A description of the incident is noted as injuries sustained consistent with blast, blast overpressure, damage to ears, neck and back after his convoy and dismounted patrol came under enemy fire from RPGs and SAF over a 3-day period in Gaza City, Afghanistan. The document is not authenticated with recommendations from his chain of command. 11. He provides a DD Form 1610 authorizing special mission temporary duty travel to Afghanistan and return effective 14 March 2018 and a Per Diem and Reimbursable Expenses document from the Defense Travel System dated 26 March 2021. 12. By regulation, the Purple Heart is awarded for a wound sustained in action against an enemy or as a result of hostile action. Substantiating evidence must be provided to verify the wound was the result of hostile action, the wound must have required medical treatment, and the medical treatment must have been made a matter of official record. BOARD DISCUSSION: 1. After reviewing the application, all supporting documents, and the evidence found within the military record, the Board found relief is warranted. 2. The Board found the medical evidence and statements provided by the applicant confirm the injuries he incurred on 12 August 2018 met the criteria for the Purple Heart. The Board determined he should be awarded the Purple Heart. BOARD VOTE: Mbr 1 Mbr 2 Mbr 3 :X :X :X GRANT FULL RELIEF : : : GRANT PARTIAL RELIEF : : : GRANT FORMAL HEARING : : : DENY APPLICATION BOARD DETERMINATION/RECOMMENDATION: The Board determined the evidence presented is sufficient to warrant a recommendation for relief. As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by awarding him the Purple Heart for wounds incurred as a result of hostile action on 12 August 2018. 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. Title 10, U.S. Code, section 1552(b), provides that applications for correction of military records must be filed within 3 years after discovery of the alleged error or injustice. This provision of law also allows the ABCMR to excuse an applicant's failure to timely file within the 3-year statute of limitations if the ABCMR determines it would be in the interest of justice to do so. 2. Army Regulation 600-8-22 prescribes Army policy, criteria, and administrative instructions concerning individual and unit military awards. a. The Purple Heart 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 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. When contemplating an award of the Purple Heart, 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 Purple Heart include concussion injuries caused as a result of enemy-generated explosions resulting in a mild TBI (mTBI) or concussion severe enough to cause either loss of consciousness (LOC) 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 Purple Heart include post-traumatic stress disorder (PTSD), hearing loss and tinnitus, mTBI or concussions that do not either result in LOC 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 Purple Heart for a mTBI 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. 3. Army Directive 2011-07 (Awarding the Purple Heart), 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 mTBI 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 Purple Heart 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 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 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 Purple Heart 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 Purple Heart: (1) Diagnosis of concussion or mTBI; (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 Purple Heart: (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. 4. 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) AR20220007604 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1