IN THE CASE OF: 
BOARD DATE: 20 December 2023 
DOCKET NUMBER: AR20230003548 


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)

•Memorandum, Self-Authored Statement, 30 January 2023

•3 DD Forms 214 (Certificate of Release or Discharge from Active Duty)



•7 May 2010

•20 May 2015

•16 August 2016



•Orders: 47-072-0008, Headquarters, Utah National Guard, 13 March 2017

•5 Image Overlays of Afghanistan/Pakistan Region

•10 pages of Military Acute Concussion Evaluation (MACE) information, 17 July2017

•13 pages of Standard Form (SF) 600 (Chronological Record of Medical Care)

•3 DA Forms 2823 (Sworn Statement)

•DA Form 2166-9-2 (Noncommissioned Officer Evaluation Report (NCOER)),31 May 2016 – 30 May 2017

•Permanent Orders 209-004, Combat Infantryman Badge (CIB), 28 July 2017

•Permanent Order Number 219-041, Bronze Star Medal (BSM), 7 August 2017,with Narrative and Citation

•DD Form 215 (Correction to DD Form 214), 13 October 2017

•DA Form 2173 (Statement of Medical Examination and Duty Status), 31 October2017

•Permanent Order Number 326-003, BSM with "V" Device, 22 November 2017,with Narrative and Citation

•Dd Form 214, 8 December 2017

•Enlisted Record Brief (ERB), 14 October 2018

•DA Form 4187 (Personnel Action), 2 April 2019

•4-page Applicant Narrative, 10 April 2019











•Memorandum, Headquarters, 5th Armored Brigade, 1 November 2017, with email, 17 April 2019•United States Special Operations Command (USSOCOM) Comprehensive Assessment and Symptom History, 13 November 2019•Memorandum, U.S. Army Human Resources Command (AHRC), 3 March 2021•Memorandum for Record (MFR), Captain (CPT) , 5 September 2021•Memorandum, Sergeant Major (SGM) (Retired) SCG, undated•2-page Department of Veterans Affairs (VA) Neurology Consult Note, 9 January 2023•2-page VA Neurology Consult Note, 13 January 2023



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 several incidents of incoming enemy explosive rounds detonating on their positions. Quick "on the scene assessments" were limited due to the ongoing combat but led him to experience and assess "bell being rung", concussion, and confusion in members of the team and himself, for a short period of time. 

b.Upon completion of their operation and stabilizing in a Rest Over Night (RON)site, the applicant and their senior medic began to receive complaints from all members of TBI type of symptoms. These symptoms included, but were not limited to, headache, sore neck, fatigue, malaise, seeing stars, light headedness, dizziness, confusion, vertigo, amnesia, loss of consciousness, flushing, and extreme sleepiness. After examining each member and each other it was decided to begin to fall back to their previous RON site and initiate a withdrawal out of the valley as they were up for a rotation with another team to be Relieved In Place (RIP). 

c.This decision was critical as everyone on the team was placed on restriction fromfull duty for 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. Medical evacuation could not be safely called at the position they took control of at the end of that operation, and they had no means of running security for themselves in their state of injury. 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 medical evacuation (MEDEVAC) in the event anyone deteriorated further or showed emergency symptoms. 

d.He and the senior medic continued to monitor the members of the team thefollowing day and saw minimal improvement. They continued full restriction from full duty and the other team was scheduled to RIP them that night. They first 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. Lower level medical providers did these interviews first, and while they were all having symptoms, that he believes, affected some of their answers. Then, they were 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 Airfield (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-hour restriction from full duty (now totaling 144 hours) and follow up care. Their leadership  and senior medic who was also the S-1 were showing emergency symptoms and were evacuated to Germany for further care. The rest of the team was on restriction from full duty status and under his observation for over a week. They had mission requirements and another team depending on them that pushed them to get back to operating in the valley. 

f.The evacuation of their leadership and senior S-1, both of which were familiar andresponsible for filling out paperwork for administrative items, notably a Purple Heart award, were no longer with them and 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 SGM approached him. He looked at their paperwork and immediately ordered him to get with his chief in the S-1 awards department and put together a Purple Heart 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 get the proper treatment required to maintain a healthy life and minimize further damage. During this time other members of the team began to be awarded the Purple Heart. 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 Purple Heart before others, and some were not completed at all.  

2.The applicant is currently serving in the Active Guard/Reserve with Company B, 1stBattalion, 19th Special Forces Group. Evidence shows he served in Afghanistan from26 April to 4 October 2017, in support of Operation Freedom's Sentinel.

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 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 applicant's statements 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.Undated statement from the former Special Forces Operations Detachment-AOperations SGM who claims on 17 July 2017, he was the applicant's direct supervisor. He attests the applicant was placed on light duty for 7 days at the BAF hospital. 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 the SOTF-A Surgeon evaluated the applicant and removed him from duty for a period greater than 48 hours due to persistent neurologic findings consistent with TBI.  

c.10-pages of MACE information from 17 July 2017. Applicant notes a head injuryevent with feeling of a blast wave and blow to the head resulting in an alteration of consciousness for 2 minutes with no loss of consciousness (LOC). Eyes, speech, and balance were considered abnormal. Applicant noted headache, dizziness, nausea, irritability, ringing in the ears and balance problems. MACE results 20 of 30. 

d.SF 600, 28 July 2017, in which the applicant was seen for TBI reportingheadache on both sides lasting for more that a week. Headache worse with light, noise, but relieved by sleep. Applicant complained of an inability to focus on one thing at a time and reading rate has decreased immensely. Applicant diagnosed with a concussion with no LOC and TBI. Instructed to practice brain rest for the next 72 hours. 

e.3-pages of LOD information which shows LOD approval for TBI for incident on21 May 2017. Applicant notes he believes the date is different because TBI can be caused by many things, and since his deployment involved multiple fire fights with blast involvement, they put the start of his deployment instead of 17 July 2017, which was his last incident. 







f. Sworn statements from the applicant, 1 April 2019, Staff Sergeant (SSG) , 12 April 2019, and SSG , 11 April 2019, which support the applicant's statement dated 30 January 2023, listed above. g. CIB orders for actions in combat on 1 June 2017. BSM orders, narrative, andcitation for exceptionally meritorious service as a Special Forces Junior Medical Sergeant from 1 May to 1 October 2017. BSM with "V" Device orders, narrative and citation for exceptionally valorous actions while serving as a Special Forces Medical Sergeant on 17 July 2017. The applicant distinguished himself by completely exposing himself to direct sustained enemy fire while engaging multiple enemy positions thereby protecting friendly elements pinned down by a near enemy ambush.  h. 4-page USSOCCOM Comprehensive Assessment and Symptom History,13 November 2019, applicant noted primary concerns of sleep, fatigue, tinnitus, headaches, nightmares and cumulative TBI symptoms. Reported persistent symptoms 6 months after deployment to Afghanistan. Diagnosed by a medical officer with TBI with concussive symptoms from incoming enemy explosive rounds on 17 July 2017.  i. VA Neurology consult notes from 9 and 13 January 2023, for memory, TBI and headache concerns. An EEG was performed due to suspected epileptic seizures and determined focal slowing in the right occipital region. Focal slowing is a non-specific abnormality suggestive of underlying focal cerebral dysfunction from any etiology particularly a structural lesion. Clinical correlation was recommended. A prolonged study could be considered.  

4.On 3 March 2021, the Chief, Awards and Decorations Branch, AHRC, disapprovedhis request for the Purple Heart for injuries received while deployed in support ofOperation Freedom's Sentinel. After a thorough review of the information provided andconsultation with the AHRC Office of the Surgeon General, the forwardedrecommendation for award of the Purple Heart did not meet the statutory guidanceoutlined in Army Regulation 600-8-22 (Military Awards), paragraph 2-8g.(13), stating,"mTBI that does not result in loss of consciousness or restriction from full duty for aperiod greater than 48 hours due to persistent signs, symptoms, or physical finding ofimpaired brain function."

5.Army Regulation 600-8-22 contains the regulatory guidance pertaining to entitlementto the Purple Heart and requires all elements of the award criteria to be met. There mustbe proof a wound was incurred as a result of enemy action, that the wound requiredtreatment by medical personnel, and that the medical personnel made such treatment amatter of official record. Additionally, when based on a TBI, the regulation stipulates theTBI, or concussion 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 the concussive 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 andthe U.S. Army Human Resources Command - Awards and Decorations Branch advisoryopinion, the Board agreed with the advising official finding the applicant did not meet thecriteria for award of the purple heart based on regulatory guidance stating theapplicant’s "mTBI that did 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. The Board noted the applicant’s witness statements from hispeers who recounted the incident and his leadership's support for award of the purpleheart. The Board carefully reviewed all the supporting medical documentation but foundit to be insufficient to grant relief based on regulatory guidance.2.Furthermore, during deliberation the Board found insufficient evidence that showedthe applicant’s name on the casualty listing or notification to his family that he had beenwounded/injured nor annotation on his 2-1 (Personnel Date Sheet) that the applicantwas wounded/injured. The medical records provided discussed his medical screeningand neurology consult in January 2023, but did not show the applicant received woundsor injuries caused by enemy forces that required immediate treatment by medicalpersonnel. Per the regulatory guidance on awarding the Purple Heart, the applicantmust provide or have in his service records substantiating evidence to verify that he wasinjured, the wound/injury was the result of hostile action, the wound or injury must haverequired treatment by medical personnel, and the medical treatment must have beenmade a matter of official record. Additionally, careful consideration was given to theapplicant’s BSM citation where he distinguished himself by completely exposing himselfto direct sustained enemy fire while engaging multiple enemy positions therebyprotecting friendly elements pinned down by a near enemy ambush.3.The Board determined criteria was not met in accordance with paragraph 2-8c of thecurrent regulation which states to qualify for award of the PH the wound or injury musthave been of such severity that it required treatment [at the location], not merelyexamination, by a medical officer, and treatment of the wound would be documented inthe service member’s medical and/or health record. Based on this, the Board foundreversal of HRC denial is without merit. Therefore, 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 Purple Heart is awarded for a wound sustained while in action against anenemy 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 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 Purple Heart 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 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. 
2.  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 Purple Heart 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 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 (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 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. 
 
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.  
 
//NOTHING FOLLOWS//