IN THE CASE OF:	   

		BOARD DATE:	  16 October 2014

		DOCKET NUMBER:  AR20140002806 


THE BOARD CONSIDERED THE FOLLOWING EVIDENCE:

1.  Application for correction of military records (with supporting documents provided, if any).

2.  Military Personnel Records and advisory opinions (if any).


THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE:

1.  The applicant requests award of the Purple Heart.

2.  He states:

	a.  The Awards and Decorations Branch, U.S. Army Human Resources Command (HRC), unjustly denied award of the Purple Heart for an injury he incurred in Iraq from an enemy explosion and subsequent fall on his head resulting in a traumatic brain injury (TBI).  His life-altering injury meets the intent of Army Regulation 600-8-22 (Military Awards) for a Purple Heart.  The Army's denial conflicts with a Department of Veterans Affairs (VA) award of a 100 percent service-connected disability rating due to the same enemy explosion and subsequent fall on his head.  

	b.  The Army wrongfully discredited statements from his commander, a battalion medical officer, the battalion medical officer's noncommissioned officer in charge (NCOIC), and a doctor of endocrinology who says he has empty sella syndrome (ESS), a condition that developed from TBI and was the prelude to several other medical conditions.  On 31 January 2011, the VA recognized his TBI as Gulf War incurred to include secondary disabling conditions.  

3.  He provides 16 documents identified in a list.  




CONSIDERATION OF EVIDENCE:

1.  With prior service in the Army National Guard, on 6 September 1985, the applicant enlisted in the Regular Army (RA).  He served in the RA until he retired as a first sergeant/E-8 on 31 December 2005.  

2.  He provides orders showing he was ordered to deploy to Iraq with Company A, 1st Battalion, 25th Aviation Regiment, for a period of 365 days or until the mission was completed.  

3.  His DD Form 214 for the period ending 31 December 2005 shows he was deployed to Iraq from 13 January 2004 to 12 January 2005.  

4.  The available records are void of documentation showing he was recommended for or awarded the Purple Heart.  

5.  His service medical records are not available for review.

6.  He provides several documents in support of his request, including the following:

	a.  In a letter, written to the VA, dated 20 January 2011, an officer identifies himself as the applicant's former unit commander and states he remembers the applicant being directly exposed to several mortar and rocket blast waves, which led to a head injury after a fall during an enemy engagement at Taji, Iraq.  He states that, on 24 April 2004, the applicant fell and bumped his head after experiencing blast wave exposure from several rocket attacks that left four of their comrades dead.  On 24 May 2004 and again on 6 June 2004, he was exposed to blast waves after numerous mortar rounds fell on their camp.  He recalls the applicant talking about his frequent headaches and application of an ice pack to his head after a fall on 24 April 2004.  He states the applicant also had sleeping issues.  He believes the applicant's sleep disorder, headaches, irritability, anxieties, excessive daytime tiredness, lack of energy, and moodiness are directly related to his head trauma.  

	b.  In a statement, dated 3 January 2012, an individual identifies himself as a former "combat medic NCOIC" and states he treated the applicant on 24 April 2004 shortly after he sustained a head injury after falling on his head.  This individual states the injury was the direct result of an enemy rocket attack on Camp Taji, Iraq.  The applicant complained of seeing stars for approximately 30 minutes, sensitivity to light, and loss of balance.  He was given quarters for 72 hours after being treated with Motrin and an ice pack.  His injuries were such that they would have required treatment by a medical officer if one had been available.  

	c.  In a letter, dated 14 September 2012, the Deputy Chief, Awards and Decorations Branch, HRC, notified the applicant that his request for award of the Purple Heart for injuries received while deployed in support of Operation Iraqi Freedom had been closed and the Awards and Decorations Branch would take no further action on his request.  The letter stated the Awards and Decorations Branch had determined his injury was not sustained as a result of enemy action and therefore did not meet the criteria for award of the Purple Heart.  

	d.  A VA Rating Decision, dated 9 October 2012, shows he was granted a 10 percent service-connected disability rating for TBI effective 31 January 2011.

	e.  In a letter, dated 23 January 2013, an endocrinologist states the applicant has been diagnosed with post-traumatic hypopituitarism, ESS, and has several secondary related health ailments.  The endocrinologist states the most likely cause of the applicant's disorder can be linked to his exposure to pressure waves from explosions and a resulting fall on his head during combat.  He states a mild to severe TBI could cause post-traumatic hypopituitarism.  

	f.  In a statement, dated 25 August 2013, an individual identifies herself as the former OIC of the 1st Battalion, 25th Aviation Regiment, Medical Station and states she and her NCOIC provided medical care to the applicant during their deployment.  On 24 April 2004, the NCOIC was the medical professional who treated the applicant for a mild TBI moments after the applicant fell on his head as the direct result of an enemy rocket attack on Camp Taji, Iraq.  The applicant was given Motrin, an ice pack, and 72 hours of rest to recuperate from his injury.  The extent of his injuries was such that he would have required treatment by a medical officer if one had been available to treat him.   

	g.  A VA Rating Decision, dated 13 November 2013, shows, in part, he was granted a 100 percent service-connected disability rating for ESS (hypopituitary) effective 31 January 2011.  Service connection for ESS (hypopituitary) was established as related to his service-connected TBI.  The VA examiner found it at least as likely as not that his ESS was a result of his service-connected TBI.  

7.  Various news articles confirm that Camp Taji, Iraq, was attacked by an enemy force on 24 April 2004 and that the attack resulted in several casualties.  



8.  Army Regulation 600-8-22 (Military Awards) states 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.

9.  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 Army Regulation 600-8-22 to reflect the clarifying guidance.  It states:

	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 mild traumatic brain injury; 

		(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 magnetic resonance imaging (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.

DISCUSSION AND CONCLUSIONS:

1.  The evidence of record shows the applicant incurred a TBI on 24 April 2004 at Camp Taji, Iraq, after falling on his head.  Various news articles confirm an enemy attack occurred at Camp Taji on that date.  Although his service medical records are not available for review, statements from the OIC and NCOIC of his battalion's medical station show he received treatment for symptoms consistent with a mild TBI.  The OIC, a medical officer, states his injuries were such that he would have required treatment by a medical officer if one had been available.  

2.  The Awards and Decorations Branch, HRC, determined that his injury was not sustained as a result of enemy action and therefore did not meet the criteria for the Purple Heart.  Notwithstanding that determination, the evidence of record shows no reason to doubt the statements of his former commander or the OIC and NCOIC of his battalion's medical station, who assert that he was exposed to blast waves from several rocket attacks on the date in question and that he fell on his head as the direct result of an enemy rocket attack.  In the absence of documentary evidence contradicting these statements, it would be appropriate to resolve any doubt in the applicant's favor by accepting the statements as evidence that the applicant was injured as a result of hostile action and his injury required treatment by medical personnel.  

3.  Accepting that he was injured as a result of hostile action and that his injury required treatment by medical personnel, the only missing element for award of the Purple Heart is evidence that both diagnostic and treatment factors were present and documented in the Soldier’s medical record by a medical officer.  Medical personnel who were present at the time have verified both diagnostic and treatment factors.  It is reasonable to presume that they would have created a record if the operational tempo allowed for doing so.  

4.  In view of the foregoing, it would be appropriate to award the applicant the Purple Heart for the TBI he incurred as a result of enemy action on 24 April 2004.  

BOARD VOTE:

____x___  ____x____  ____x__  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

________  ________  ________  DENY APPLICATION

BOARD DETERMINATION/RECOMMENDATION:

The Board determined that the evidence presented was sufficient to warrant a recommendation for relief.  As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by: 

	a.  awarding him the Purple Heart for the injury he incurred on 24 April 2004; and

	b.  correcting his DD Form 214 for the period ending 31 December 2005 to show the Purple Heart.



      ____________x_____________
                  CHAIRPERSON
      
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.

ABCMR Record of Proceedings (cont)                                         AR20140002806



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ABCMR Record of Proceedings (cont)                                         AR20140002806



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