Mild brain injury could soon rate Purple Heart - Army News | News from Afghanistan & Iraq - Army Times

Mild brain injury could soon rate Purple Heart

More U.S. troops who sustain combat-related brain injuries could soon be eligible for the Purple Heart.

Senior military leaders at the Pentagon are considering individual service proposals to change the guidelines for awarding the medal to troops who sustain mild traumatic brain injuries or concussions, Military Times has learned. The Purple Heart recognizes U.S. military personnel wounded or killed by enemy action.

It’s not immediately clear whether any new guidelines would allow for Purple Hearts to be awarded retroactively.

Officials from all four services are scheduled to meet this week with Dr. Clifford Stanley, undersecretary of defense for personnel and readiness, to discuss the recommended changes, said Army Lt. Col. Steve Warren, a spokesman for Vice Chief of Staff Gen. Peter Chiarelli, who is leading the Army’s initiative.

“Up to now, he thinks soldiers have received concussions and not received Purple Hearts as they should,” Warren said.

Marine Commandant Gen. Jim Amos ordered the Marine Corps’ review to account for new research indicating the severity of a head wound is not necessarily linked to being knocked unconscious on the battlefield, as current Purple Heart criteria dictate, Marine officials said, noting that in some cases, the long-term effects can be far worse.

The issue, Warren said, is “what is a concussion?” The regulation, he said, awards Purple Hearts for concussions, but “do you have to be knocked out? Does your head have to bleed?”

Marine officials would not discuss details of their proposal.

Since 2000, more than 202,000 U.S. troops have been diagnosed with some form of TBI, according to Defense Department data. Most — more than 150,000 cases — were classified as “mild.” Annual numbers have risen in step with the proliferation of improvised explosives as the weapon of choice among insurgents targeting U.S. troops in Afghanistan and Iraq. Nearly 31,000 suffered a brain injury last year alone.

Existing guidelines, in place since shortly after U.S. forces invaded Afghanistan in 2001, are based on the American Academy of Neurology’s definitions for mild TBI and concussions, Marine officials said. Early on, head injuries were thought to be less serious if a soldier or Marine didn’t black out as a result of the trauma he experienced.

Plus, officials said, for the purposes of verifying an injury and subsequent eligibility for a Purple Heart, it’s fairly easy to observe whether one of your squadmates was knocked out by the blast he encountered.

Along with post-traumatic stress disorder, TBI has been called a signature wound of the wars in Afghanistan and Iraq. It can cause mood swings, memory loss, depression and paranoia, among other symptoms. Initial detection, however, can be problematic — especially in instances where troops don’t lose consciousness. At first, TBIs can appear to be symptom-free.

The Pentagon has stepped up its response as a result. Amos and Chiarelli, in particular, have advocated for enforcing better war-zone standards to identify head injuries as soon as they occur with hopes of reducing the chances they’ll lead to long-term problems.

Since last summer, the military has required 24-hour rest for any personnel suffering even a mild concussion. After a second head injury, they’re forced to spend seven days with no physical activity. A third head injury requires evaluation by a neurologist in theater.

Amos has referred to this approach as “three strikes and you’re in,” meaning inside the wire.

The Purple Heart traces back to Gen. George Washington and the Continental Army, though it was not issued for more than 100 years after the American Revolution ended. More than 40,000 have been awarded to U.S. troops since the invasion of Afghanistan, according to records maintained by the Military Order of the Purple Heart, an organization of medal recipients.