IN THE CASE OF: BOARD DATE: 13 December 2023 DOCKET NUMBER: AR20230004980 APPLICANT REQUESTS: a. Correction of her DD Form 214 (Certificate of Release or Discharge from Active Duty) for the period ending 20 December 2011 to show she was entitled, authorized, and awarded the Purple Heart. b. A personal appearance before the Board. APPLICANT'S SUPPORTING DOCUMENTS CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of Military Record) * Personal Statement * Orders LS-104-0094, dated 14 April 2011 * Combat Action Badge (CAB) Certificate, dated 25 May 2011 * Memorandum from Applicant, dated 28 June 2011 * Sworn Statement * Physical Profiles * DA Form 2-1 (Personnel Qualification Record) * Medical Records * DD Form 214, 20 December 2011 * U.S. Army Human Resources Command (HRC) Denial Letter, dated 13 January 2017 * Department of Veterans Affairs (VA) Disability Rating, dated 23 June 2017 * HRC Reconsideration Denial Letter, dated 20 July 2018 FACTS: 1. The applicant did not file within the three-year time frame provided in Title 10, United States Code (USC), 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. She should have been entitled and awarded the Purple Heart. The denying of the Purple Heart is unjust because she did not get proper care or diagnosed in theater, nor did she find out what was wrong with her until after she got home from her deployment in Iraq. She received a referral to a neurologist who diagnosed her with a traumatic brain injury (TBI), which she sustained during a blast in Iraq. b. While in Iraq, she had gone to the medics for a head cold, headache, and ringing in the ears and was given a sick-call slip for quarters. At the time of the event, she was on an outpost, not controlled by her unit and the only medical records of the event are the sick-call slips that she retained and her CAB Certificate. c. She got home and every doctor has linked her TBI to the blast where she lost consciousness. To say that the military is unable to connect her disability to an injury that qualifies her for a Purple Heart is unjust. The Purple Heart includes TBI, the Army policy states that the Purple Heart can be awarded for "Mild TBI injury or concussive severe enough to cause either loss of consciousness or restriction from full duty due to persistent signs, symptoms, or clinical finding, or impaired brain functions for a period greater than 48 hours from the time of the concussive incident”. Which due to the lingering symptoms she was having, she was restricted from full duty for longer than 48 hours a total of 72 hours. d. She feels that the decision from HRC is unjust and penalizes her for the lack of medical care and misdiagnoses her TBI that she sustained in theater, and the lack of personal treatment records is not her fault. It also seems to be the thought of HRC that seeking a Purple Heart for a qualifying TBI event is as they put it seeking recognition for the physical toll to which the body is subjected while in combat. To HRC, if you do not bleed, your injuries do not count. 3. The applicant provides the following documentation: a. Combat Action Badge (CAB) Certificate, dated 25 May 2011, states she received the CAB for combat action on 25 May 2011 for having been personally present and under hostile enemy fire while serving with the 219th Battlefield Surveillance Brigade in support of Operation New Dawn in Iraq. b. Sworn Statement by Sergeant (SGT) HXXXXXX HXXXXX, dated 26 May 2011, states, that he and the applicant were seeking medical attention at the battalion aid station tent; she for allergy related ailments. While there, there was a big explosion, and he was able to reach safety without injury. The Explosive Ordnance Device Team indicated that a 107mm rocket had landed approximately 75-80 meters from their tent. He and the applicant reported the event. c. Physical Profiles: * dated 30 April 2012, reflects she was on a temporary profile until 30 July 2012 for migraines and a wrist ligament tear. * dated 4 September 2012, reflects she was on a temporary profile of “T3” (Upper Extremity) due to her inability to drive until 23 November 2012, due to wrist pain and migraines d. Medical Records, which will be reviewed and discussed by the Behavior Health Staff at the Army Review Boards Agency. e. A letter issued by HRC, dated 13 January 2017, reflects she submitted a request for a Purple Heart. Her request was denied due to the lack of supporting medical documentation, making it impossible to connect an injury to her incident. f. A VA Disability Rating letter, dated 23 June 2017, shows she was given a 40 percent disability rating for post traumatic stress disorder with a TBI and residual right upper extremity tremors, effective 9 August 20167. In addition, she was given a totally and permanently disability rating due to her service connected disability. g. In a letter from HRC responding to a reconsideration request from the applicant, it shows that HRC denied her reconsideration on 20 July 2018. They state, “We acknowledge receipt of the various medical documents provided in support of your request. While these documents are supportive for your Department of Veterans Affairs ...medical care, these documents are not definitive enough to connect a singular incident to a wound or injury. The Purple Heart requires medical documentation from the time outlining wounds or injuries as a direct result of a singular enemy action that required treatment by a medical officer.” 4. The applicant’s service records shows the following information: a. On 7 January 2006, the applicant enlisted in the Army National Guard. b. DD Form 214 for the period ending 24 March 2007, shows she was honorably release from active duty due to pregnancy or childbirth. c. On 10 March 2011, she enlisted in the U.S. Army Reserves. d. Orders LS-104-0094, dated 14 April 2011 shows she was deployed in a Temporary Change of Station status in support of Operation New Dawn in Baghdad, Iraq on 6 May 2011 for a period of 344 days. e. DD Form 214, dated 20 December 2011, reflects she was honorably released from active duty to the completion of her required active service. She completed 9 months and 11 days of net active-duty service. 5. The applicant’s records are void of orders of a Purple Heart. 6. MEDICAL REVIEW: a. The Army Review Boards Agency (ARBA) Medical Advisor reviewed the supporting documents, the Record of Proceedings (ROP), and the applicant's available records in the Interactive Personnel Electronic Records Management System (iPERMS), the Health Artifacts Image Management Solutions (HAIMS) and the VA's Joint Legacy Viewer (JLV). The applicant requests the Purple Heart award for traumatic brain injury (TBI) sustained 25May2011 in Iraq. She reported blast exposure with loss of consciousness, headache, and ringing in her ears. She endorsed memory loss of everything that happened after the impact in her 16Aug2016 memorandum for record. And finally, in the memorandum, the applicant reported having found out that she injured her wrist for which she was treated with a brace and pain medication in theatre. She did not state how the right wrist injury occurred. b. The applicant’s record was summarized in the ABCMR ROP. Of pertinence, she was a member of USAR and deployed to Iraq from 20110507 to 20111110 with MOS 35M20 Human Intelligence Collector. c. TBI. Pertinent medical records and related. * 28Feb2007 87th Medical Group Primary Care Note. The applicant was seen for migraines. She reported a history of migraine headaches since age 17. She usually experienced them 3-4 times per month, and they were usually relieved with Excedrin. * 25May2011 Individual Sick Slip. The visit was for a head cold. She was given quarters for the day. * 25May2011 Theatre Facility. The applicant was seen for sinus congestion of 3 days duration. It was documented that there was no head, neck, eye, ear, psychological, or neurological symptoms. She did have nasal discharge and postnasal drip. There was no sore throat. Symptoms were confined to the upper respiratory area—a viral upper respiratory tract infection was suspected. She was confined to the upper respiratory area and given work duty limitations. If symptoms persisted, she was to return for antibiotics. Disposition for Illness & Injury: Non-battle related. According to the applicant’s 28Jun2011 statement, she was seen at sick call for illness prior to the blast. After the blast, she was seen again by medics because of ringing in her ears and a mild headache while in the bunker awaiting the all clear. She checked out of sick call after the blast. * 26May2011 Individual Sick Slip. The note indicated follow up for a head cold, blast exposure and headache. She was given quarters for 48 hours. * 26May2011 Theatre Facility. The applicant was seen in follow up and she provided further history: She had experienced a dry cough for the past week, sinus pain, green nasal drainage, chills at night and irritated throat (not sore throat). The cough was worse at night. A developing sinusitis was suspected based on reported symptoms and facial pressure. She was treated with antibiotics. A blast exposure was not discussed. * 13Nov2011 Post Deployment Health Assessment (Iraq). The applicant reported on DD Form 2796 that she had blast exposure (9a) ringing in ears and headaches (9c). She endorsed feeling dazed, confused, or ‘saw stars’ immediately after blast (9b). She denied loss of consciousness, concussion, and head injury (9b). * 27Mar2012 45th Medical Group Family Practice Note. The applicant reported having a headache for 3 days. This was the 4th time she had bad migraines this month and they had progressively gotten worse and lasted longer. She used to get them once a month and now it seems to be once a week. She thinks the migraine may have to do with being involved just outside a blast radius of a rocket attack in Iraq. * 26Dec2012 Post Deployment Health Reassessment (Iraq). She reported headaches, ringing in ears, trouble concentrating, being forgetful, and increased irritability. She reaffirmed having had blast exposure and feeling dazed, confused, or ‘saw stars’ immediately after blast. She denied loss of consciousness, and amnesia. During this assessment, she endorsed having experienced a head injury and concussion and the following symptoms: Memory problems, ringing in ears, sensitivity to bright light, irritability, and headaches. * 16Mar2017 Initial TBI DBQ. The applicant reported that the first significant head injury occurred about 30Apr1998 as she trained to ride horses for caisson duty. She was bareback on a horse, when it unexpectedly reared and she somersaulted off the horse landing on her head and back. She blacked out briefly and was sent to the barn to rest where she fainted again. She felt dazed awhile and ultimately received “some basic medical care”. The VA examiner stated this injury was documented in service treatment records from early May 1998. The second most significant head injury occurred when a 107mm mortar round exploded about a hundred feet away from her as she stood in the open. She reported that she felt the blast on the right side of her body and was briefly dazed. The VA examiner, a neurologist, confirmed TBI diagnosis for both May 1998 head injury due to the horse accident and the May 2011 motor blast. d. Right Wrist Condition * 17Oct2011 OPC (Theatre Facility). The applicant reported having broken the right wrist 12 years prior due to falling backwards on it. She reported the injury resulted in limited mobility of the joint. She denied recent trauma but had experienced the onset of right wrist pain about three days prior. The provider suspected osteoarthritis and treated the wrist pain with splinting and ibuprofen. * 29Nov20112 45th Medical Group. The applicant reported 2 prior wrist surgeries. * 21Mar2017 Wrist Conditions DBQ. The following history was noted: 1998/1999 she slipped and fell while walking through the barracks with her taps after they had just used armor all on the black mats; 2011, while in Iraq, she had wrist pain without preceding injury/trauma; October 2012 she underwent ganglion cyst excision; and on 25Jan2013, she was diagnosed with a triangular fibrocartilaginous complex (TFCC) injury. e. Per AR 800-8-22, chapter 2-8, concussions (and/or mild traumatic brain injury (mTBI)) caused as a result of enemy-generated explosions that result in 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, are qualifying. Clarifying guidance on awarding of the Purple Heart for concussions provides that in addition to the criteria in paragraph 2-8, that both diagnostic and treatment factors should be present and documented in the Soldier’s medical record by a medical officer. f. The 28Jun2011 sworn statement by the applicant and 30Aug2011 sworn statement by SGT H_N_ described both the pre and post impact events of the 25May2011 blast exposure in Iraq. The 26May2011 Individual Sick Slip also affirms a blast exposure. The blast exposure on 25May2011 is acknowledged; however, characteristic TBI signs/symptoms were not documented during the clinical examination(s) that took place at the time. In contrast, symptoms consistent with upper respiratory symptoms were documented. A sinus infection was suspected for which antibiotic treatment was started. It reasonably follows that the 48 hours quarters was given as treatment for the upper respiratory tract infection/sinus infection rather than for residual signs/symptoms of a concussive incident. Based on records available for review today, evidence does not support that the applicant sustained a concussion and/or mild TBI that resulted in loss of consciousness on the day of the concussive event or required restriction from full duty due to persistent signs, symptoms, or clinical finding, or impaired brain function for a period greater than 48 hours. Concerning the right wrist condition, there were no combat related service treatment records for the right wrist condition that were available for review. Recommend concur with U.S. Army HRC denial of the Purple Heart award due to lack of supporting medical documentation. BOARD DISCUSSION: 1. After reviewing the application and all supporting documents, the Board found that relief was not warranted. The Board carefully considered the applicant's record of service, documents submitted in support of the petition and executed a comprehensive and standard review based on law, policy and regulation. Upon review of the applicant’s petition and available military records, the Board concurred with the advising official finding the records available for review today, evidence does not support that the applicant sustained a concussion and/or mild TBI that resulted in loss of consciousness on the day of the concussive event or required restriction from full duty due to persistent signs, symptoms, or clinical finding, or impaired brain function for a period greater than 48 hours. 2. The governing regulation provides that for award of the Purple Heart, evidence provided must indicate he suffered, as a result of hostile action, a concussion or TBI so disabling as 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 incident. The applicant has no medical documentation showing a loss of consciousness nor that shows she was restricted from duty for a period equaling 48 hours or more. The Board agreed there was insufficient evidence that showed the applicant’s name on the casualty listing or notification to her family that she had been wounded. There is no medical record showing the applicant received wounds caused by enemy forces that required treatment by medical personnel. Therefore, the Board denied relief to reverse the HRC award decision. 3. 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. 4. The applicant’s request for a personal appearance hearing was carefully considered. In this case, the evidence of record was sufficient to render a fair and equitable decision. As a result, a personal appearance hearing is not necessary to serve the interest of equity and justice in this case. 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. Title 10, USC, section 1552(b), provides that applications for correction of military records must be filed within three 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 three-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 (Military Awards) 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 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, 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 Purple Heart 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. 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 Purple Heart for concussions (including mild TBI and concussive injuries that do not result in a loss of consciousness). The directive also revised AR 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, U.S 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. 4. Army Regulation 635-8 (Separation Documents) states that the DD Form 214 will reflect the conditions and circumstances that existed at the time the records were created. The purpose of the separation document is to provide the individual with documentary evidence of his or her military service at the time of release from active duty, retirement, or discharge. It is important that information entered on the form be complete and accurate and reflects the conditions as they existed at the time of separation. Personnel officers will prepare and authenticate DD Form 214WS (Worksheet) prior to forwarding records to the transfer facility. All available records will be used as a basis for the preparation of DD Form 214WS, including DA Form 2-1 (Personnel Qualification Record) and orders. 5. Army Regulation 15-185 (Army Board for Correction of Military Records) prescribes the policies and procedures for correction of military records by the Secretary of the Army acting through the ABCMR. The ABCMR begins its consideration of each case with the presumption of administrative regularity. The ABCMR will decide cases on the evidence of record. It is not an investigative body. The applicant has the burden of proving an error or injustice by a preponderance of the evidence. Paragraph 2-11 states applicants do not have a right to a formal hearing before the ABCMR. The Director or the ABCMR may grant a formal hearing whenever justice requires. //NOTHING FOLLOWS// ABCMR Record of Proceedings (cont) AR20230004980 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1