IN THE CASE OF: 
BOARD DATE: 20 December 2023 
DOCKET NUMBER: AR20230002685 


APPLICANT REQUESTS: entitlement to the Purple Heart (PH). 

APPLICANT'S SUPPORTING DOCUMENT(S) CONSIDERED BY THE BOARD:

•DD Form 149 (Application for Correction of Military Record)•Memorandum, Applicant, 17 February 2023•Memorandum, U.S. Army Human Resources Command (AHRC), 3 March 2021•DA Form 4187 (Personnel Action), 12 September 2019•DD Form 214 (Certificate of Release or Discharge from Active Duty)•Orders: 47-072-0009, Headquarters Utah National Guard, 13 March 2017•Orders: 286-0501, U.S. Army Installation Management Command, 13 October 2017•2-page Applicant Narrative of Events•5 Image Overlays of Afghanistan/Pakistan Region•Standard Form (SF) 600 (Chronological Record of Medical Care), 17 July 2017•8 pages of Military Acute Concussion Evaluation (MACE) information, 17 July 2017•21 pages of Medical Documentation•DA Form 2173 (Statement of Medical Examination and Duty), 31 October 2017•Memorandum, Headquarters, 5th Armored Brigade, 1 November 2017•Enlisted Record Brief (ERB), 14 October 2018•Page 1, DA Form 2166-9-2 (Noncommissioned Officer Evaluation Report(NCOER))•Bronze Star Medal (BSM) Citation•BSM Narrative•DA Form 638 (Recommendation for Award), BSM, Permanent Order Number242-004, 30 August 2017•BSM with "V" Device Citation•BSM with "V" Device Narrative•DA Form 638, Army Commendation Medal (ARCOM) with "C" Device, Permanent Order Number 269-003, 26 September 2017•3 DA Forms 2823 (Sworn Statement), Staff Sergeant (SSG) , 12 April 2019, SSG , 1 April 2019, Applicant, 11 April 2019




•Memorandum for Record (MFR), , 5 September 2021•Memorandum, Sergeant Major (SGM) (Retired), Undated



FACTS: 

1.The applicant states, in effect:

a.He received a traumatic brain injury (TBI) on 17 July 2017, during intense fightingwith members of ISIS-K for over 16 hours in the Pekha Valley region of Afghanistan. The event included numerous incidents of incoming enemy explosive rounds detonating on their positions and a large enemy improvised explosive device (IED) explosion. These incidents caused him and many of his team members to be dazed, confused, concussed and some lost consciousness (LOC). Quick "on the scene assessments" were limited due to the ongoing combat. A decision was made to only use medical evacuation (MEDEVAC) for life threatening casualties. 

b.Upon completion of their operation and stabilizing in a Rest Over Night (RON)site, the medics treated him for TBI symptoms. These symptoms included, but were not limited to, severe headaches, vomiting, sore neck, fatigue, malaise, seeing stars, light headedness, dizziness, confusion, vertigo, retrograde amnesia, LOC, flushing, and extreme sleepiness. After examining each member, it was decided to begin to fall back to their previous RON site due to the medical condition of the entire team. 

c.This decision was critical as several members of the team including himself, wasplaced on restricted duty for over 48 hours per their TBI protocol. This restriction included, but was not limited to, ordered rest, and restrictions on viewing screens, standing, wearing kit, working out, and training. Their previous RON site had U.S. members of their uplift able to pull security for them and was a safe place to call for MEDEVAC in the event anyone needed further treatment or showed emergency symptoms. 

d.The medics continued to monitor the members of the team the following day andsaw minimal improvement. Another team came to replace them on 19 July 2017, while he was still on restricted duty and experiencing TBI symptoms. They fell back to Jalalabad where at Forward Operating Base (FOB) Fenty the Forward Surgical Team (FST) required them to go through a TBI screening after hearing through the radio, and combat tracking what they had all gone through. These interviews were done by lower-level medical providers first, and while he was still having symptoms, which he believes, affected some of his answers. They were then assessed individually by doctors who continued their restriction from full duty status, now totaling to 96 hours, and were required follow up care at Bagram Air Field (BAF) 455th Hospital. 

e.They were further evacuated to the BAF 455th Hospital where he and othermembers were still symptomatic from their TBI and placed on an additional 48 hours restriction from full duty (now totaling 144 hours) and follow up care. Their leadership  and senior medic (who was also the S-1), was showing emergency symptoms and were evacuated to Germany for further care. The rest of the team was on restriction from full duty and he was under his observation for over a week. They had mission requirements and another team depending on them which pushed them to get back to conducting combat missions for the remainder of the deployment which ended in October 2017. 

f.The evacuation of their leadership and senior S-1, who were familiar and
responsible for filling out paperwork for administrative items, notably a PH award, were no longer with them. This explains, in part, the delay to initiating these awards, in addition to his ignorance on the topic. Once stateside, while struggling to get simple Line of Duty (LOD) paperwork approval for the team to get the follow-on care for their TBIs and other injuries, the Utah State Command Sergeant Major saw their paperwork and immediately ordered their medic to get with his chief in the S-1 awards department and put together a PH packet as they clearly met the requirements for it. From there, the delays were out of their hands, and it was difficult to get support or gather documents from people. 

g.Once they received their LODs they were able to get more advanced screening,
assessments, and tests that confirmed their TBIs. This also helped them to get the proper treatment required to maintain a healthy life. During this time other members of the team began to be awarded the PH. Due to the different ways they were all evacuated, the different demobilization sites they were processed through, and the different commands they fell under, some got their PH before others, and some were not completed at all.  

2.The applicant is currently serving in the U.S. Army Active Guard/Reserve in therank/grade of sergeant first class/E-7. Evidence shows he served in the imminentdanger pay area of Afghanistan from 26 April 2017 to 4 October 2017.

3.The applicant provides a/an:

a.Medical Treatment Summary, 5 September 2021, from the senior medic who wasdirectly involved in the applicant's medical care on and around 17 July 2017. He states, in effect, on 17 July 2017, the applicant was exposed to multiple explosions from enemy and friendly munitions which detonated in close proximity to him. He was immediately evaluated by the Special Forces Medical Sergeant and determined to have neurologic deficits. Due to the ongoing ground battle, and inability to effect MEDEVAC, he continued to fight throughout the day. At the end of day, he was again evaluated and found to have persistent neurologic deficits as noted on his MACE exam. He was placed on restricted duty as possible given ongoing mission constraints. Once the mission was completed, the applicant was evaluated at the Role II clinic at FOB Fenty 













and placed on light duty for 7 days. He was returned to duty the following week. He agrees with the summary of events outlined by SSG  and can testify that the applicant was evaluated by himself and the Special Operations Task Force-A (SOTF-A) Surgeon and removed from duty for greater than 48 hours due to persistent neurologic findings consistent with TBI. b. Statement from the former Special Forces Operations Detachment-A Operations SGM, undated, who claims on 17 July 2017, he was the applicant direct supervisor. He attests on 17 July 2017, the applicant was exposed to multiple explosions from both enemy and friendly munitions and was placed on light duty for 7 days at BAF. This duty restriction was ordered after a medical evaluation performed at FOB Fenty Role II clinic revealed signs and symptoms of TBI. He can also attest to the applicant being under the medical care of team medics. He agrees with the summary of events as outlined by applicant in his sworn statement and can testify that applicant was evaluated by the SOTF-A Surgeon and was removed from duty for greater than 48 hours due to persistent neurologic findings consistent with TBI. c. Sworn statement from SSG            , 1 April 2019, which essentially mirrors theapplicant's statement, several images/overlays of the region, and a 3-page narrative from the applicant which informs his personal statement albeit with greater detail of the team and their movements during battle. d. 8-pages of MACE information from 17 July 2017. The applicant notes explosion/blast event with head injury, alteration of consciousness for 5 minutes with no LOC. Eyes, speech, and balance were considered abnormal. Applicant noted headache, dizziness, memory problems, nausea/vomiting, irritability, difficulty concentrating, ringing in the ears and balance problems. Initial MACE results 15/30. e. SF 600, 17 July 2017, in which the applicant was seen for minorabrasions/bruising but primarily headache, nausea, dizziness, fatigue and malaise post blast. Minor contusions and abrasions. Diagnosed with severe difficulties in both neurologic and cognitive areas. Symptomatic for TBI. Applicant told to cease the use of any explosives dependent on operation and prescribed immediate bed rest and limitation of high cognitive requiring activities, MACE exams every 2 hours for the next  6 hours and to follow-up at FOB Fenty for TBI screening. f. 2-pages of LOD information which shows LOD approval for TBI for incident on 31 July 2017 (this date is most likely an error as all other dates states 17 July 2017). Details of the incident notes the applicant had a concussion at the time of the IED blast. g. Sworn statements from the applicant, 11 April 2019, SSG , 12 April 2019 and SSG , 1 April 2019, which support the applicant's statement from above. 
h.Medical record, 30 July 2017, encounter for TBI presenting for command directedMACE 5 weeks after engagement from 17 July 2017. No TBI at this time, no symptoms to manage. The applicant was doing well and could follow up as necessary. Released without limitations.  

i.Medical record, 31 July 2017, the applicant presented for MACE after previousrocket attack. Denied LOC but reported left side headache. MACE 29/30, 48 hour recheck. Headache suspected to have to do with ocular muscle spasm. Trial of Flexeril. 

j.Medical record 9 October 2017, the applicant was not cleared to demobilize.Needed x-ray and evaluation due to constant neck pain. Radiology found mild degenerative changes in the cervical spine. Otherwise, normal soft tissues of the neck. 

k.Medical record 12 October 2017, the applicant reported medical history of chronicneck pain reaggravated during the deployment; was evaluated and cleared to demobilize. X-rays revealed degenerative changes. 

l.ERB, NCOER, and recommendations, narratives and citations for awards of theBSM and ARCOM with "C" Device. 

4.On 3 March 2021, the Chief, Awards and Decorations Branch, AHRC, disapprovedhis request for the PH for injuries received while deployed in support of OperationFreedom’s Sentinel. After a thorough review of the information provided andconsultation with the U.S. Army Human Resources Command Office of the SurgeonGeneral, the forwarded recommendation for award of the PH does not meet thestatutory guidance outlined in Army Regulation 600-8-22 (Military Awards), paragraph
2-8g(13), "mTBI that does not result in loss of consciousness or restriction from full dutyfor a period greater than 48 hours due to persistent signs, symptoms, or physical findingof impaired brain function."

5.Army Regulation 600-8-22 contains the regulatory guidance pertaining to entitlementto the PH and requires all elements of the award criteria to be met. There must be proofa wound was incurred as a result of enemy action, that the wound required treatment bymedical personnel, and that the medical personnel made such treatment a matter ofofficial record. Additionally, when based on a TBI, the regulation stipulates the TBI orconcussion must have been severe enough to cause a loss of consciousness; orrestriction from full duty due to persistent signs, symptoms, or clinical findings; orimpaired brain functions for a period greater than 48 hours from the time of theconcussive incident.



BOARD DISCUSSION: 



1.After reviewing the application, all supporting documents, and the evidence foundwithin the military record, the Board found that relief was not warranted. The Boardcarefully considered the applicant's record of service, documents submitted in supportof the petition and executed a comprehensive and standard review based on law, policyand regulation. Upon review of the applicant’s petition, available military records andU.S. Army Human Resource Command - Awards and Decorations Branch advisoryopinion, the Board concurred with the advising official finding the applicant based ongoverning regulations did not meet the criteria based on a "mTBI that does not result inloss of consciousness or restriction from full duty for a period greater than 48 hours dueto persistent signs, symptoms, or physical finding of impaired brain function.2.The Board carefully considered the applicant’s witness statements and his medicaldocumentation to include the provide LOD, however found it to be insufficient evidenceto grant relief. Furthermore, the Board agreed there was insufficient evidence thatshowed the applicant’s name on the casualty listing or notification to his family that hehad been wounded. The Board found the medical records provided by the applicantinsufficient in accordance with regulatory guidance for TBI. Per the regulatory guidanceon awarding the Purple Heart, the applicant must provide or have in his service recordssubstantiating evidence to verify that he was injured, the wound/injury was the result ofhostile action, the wound or injury must have required treatment by medical personnel,and the medical treatment must have been made a matter of official record. The Boardnoted, in accordance with paragraph 2-8c of the current regulation it states to qualify foraward of the PH the wound or injury must have been of such severity that it requiredtreatment [at the location], not merely examination, by a medical officer, and treatmentof the wound would be documented in the service member’s medical and/or healthrecord. Based on this, the Board denied relief.

BOARD VOTE: 

Mbr 1 Mbr 2 Mbr 3 

: : : GRANT FULL RELIEF 

: : : GRANT PARTIAL RELIEF 

: : : GRANT FORMAL HEARING 

:X :X :X 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. 



Microsoft Office Signature Line...
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 administrativeinstructions concerning individual and unit military awards.

a.The PH is awarded for a wound sustained while in action against an enemy or asa 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 oragent 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 musttake 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 mTBI 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, mTBI 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 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. 
 
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 mTBI and concussive injuries that do not result in a loss of consciousness). 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 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 (CT) or MRI 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.  The MACE is a standardized mental status examination that is used to evaluate mTBI, or concussion, in theater. This screening tool was developed to evaluate a person with a suspected concussion and is used to identify symptoms of a mTBI. Future MACE scores can be used to determine if the patient's cognitive function has improved or worsened over time. To be most effective, all service members experiencing concussion, or mTBI, should have the MACE administered within the first 24 hours of the event in order to make certain that proper care is administered in a timely fashion. The MACE, in combination with a medical exam, can be used to help determine if it is safe for a service member to return to duty. However, this standardized testing/evaluation was not utilized by the military until 2006.  
 
4.  Army Regulation 15-185 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//