Soldiers With Brain Trauma Denied Purple Hearts, Adding Insult to Injury

ProPublica:

High level medical officials in the Army debated whether head traumas that are difficult to detect, often leaving no visible signs of damage, warrant the award, the e-mails show. Most people who sustain such blows, also known as concussions, recover on their own, but studies show 5 percent to 15 percent may have long-term impairments.

 

In 2008, Brig. Gen. Joseph Caravalho, then the top medical commander in Iraq, issued a policy [3] blocking medical providers from even discussing the Purple Heart with soldiers who suffered mild traumatic brain injuries.

"In many cases," Caravalho wrote that concussions with "minimum medical intervention will not warrant this award."

His policy appears to contradict Army rules governing the Purple Heart.

Army regulations say that a soldier is entitled to the Purple Heart if injured by hostile action. The soldier must require treatment -- no matter how minimal -- by a medical officer, and the injury must be documented. Medical officers can offer advice on whether an injury merits recognition. The soldiers' commanding general typically makes the final decision to award or deny a Purple Heart.

The Army's official list of wounds [4] that "clearly justify" the award includes, "Concussion injuries caused as a result of enemy generated explosions."

In an e-mailed response, Caravalho, who now commands one of the Army's top hospitals, said he was trying to help medical personnel understand some of the complexities involved in the diagnosis and treatment of mild traumatic brain injuries. He did not specifically address whether his order created new restrictions on the award of the medal.

"I was trying to make the point that medical providers in the field needed to ensure they documented the event, the findings and the treatment rendered," wrote Caravalho. "Without this corroborating documentation, I felt it would be increasingly difficult to support a Purple Heart request based solely on subjective, and potentially temporary symptoms."

Gen. Peter Chiarelli, the Army's second in command, said it is "very, very clear" that soldiers who have sustained documented concussions from enemy action should receive the Purple Heart. He said he was not aware of Caravalho's order until NPR and ProPublica brought it to his attention.

"This is a good catch," he said, saying he had asked Army lawyers to review the policy to see whether it should be changed. A Chiarelli spokesman said Wednesday that, as of last week, the review was continuing.

Chiarelli, the Army's point man on the treatment of traumatic brain injury and post traumatic stress, acknowledged there is ongoing resistance to awarding the Purple Heart for so-called "invisible" wounds.

He saw it firsthand when he served as commander in Baghdad from 2004 to 2005 and said he overturned many denials for the medal stemming from concussion injuries. There has been progress since then, he said, but more work remains.

"There still are some commanders, okay, who -- and there may be some doctors, too -- who don't feel that a concussion should entitle somebody for a Purple Heart," Chiarelli said. "But we have far more commanders that understand that the concussion is a real injury today than we had in 2004 and 2005."

"We are moving in the right direction to fix this."