Purple Hearts Elusive for Traumatic Brain Injuries

The U.S. Army honors soldiers wounded or killed in combat with the Purple Heart, a powerful symbol designed to recognize their sacrifice and service.

Yet Army commanders have routinely denied Purple Hearts to soldiers who have sustained concussions in Iraq, despite regulations that make such wounds eligible for the medal, an investigation by NPR and ProPublica has found.

Soldiers have had to battle for months and sometimes years to prove that these injuries, also called mild traumatic brain injuries, merit the honor, our reporting showed. Commanders turned down some soldiers despite well-documented blast wounds that wrenched their minds, altered their lives and wracked their families.

The Army twice denied a Purple Heart for Sgt. Nathan Scheller, though the aftereffects from two roadside explosions in Iraq have left him with lasting cognitive problems, according to the Army’s own records.

The 29-year-old former tank commander navigated an M1A1 Abrams through Baghdad’s urban battlefield of bomb-strewn highways and sniper-filled alleys. Now he gets lost driving familiar routes around his home. An honor student in high school, he can no longer concentrate enough to read the adventure novels he once loved.

“I don’t see how somebody else can tell me that I don’t deserve one,” Scheller said of the Purple Heart. “I may not have wounds on the outside. But I have wounds on the inside.”

The denials of Purple Hearts reflect a broader skepticism within the military over the severity of mild traumatic brain injury, often described as one of the signature wounds of the conflicts, according to interviews, documents and internal emails obtained by NPR and 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 emails 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 blocking medical providers from even discussing the Purple Heart with soldiers who suffered mild traumatic brain injuries. Doctors were not barred from discussing the award with soldiers who have other injuries.

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

Sgt. Nathan Scheller, 29, was twice denied for a Purple Heart, though roadside bomb explosions left him with lasting cognitive damage. “I don’t see how somebody else can tell me that I don’t deserve one,” he says. Above, Scheller walks with his wife, Miriam, and his family.

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.

TBI & the Purple Heart – David Dwork – Boston Personal Injury Lawyer

The Army’s official list of wounds that “clearly justify” the award includes, “Concussion injuries caused as a result of enemy generated explosions.”

In an emailed 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.”

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.

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 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.”