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According to the regulations, a non-blood loss injury such as a TBI (Traumatic Brain Injury) caused by IED concussion or enemy generated explosions caused by rockets or mortars does merit the Purple Heart.
Ever since the original Badge of Military Merit was reninstituted as the Purple Heart by War Department General Orders No. 3, dated 22 February 1932, there has been an argument about what specifically constitutes an award of the Purple Heart; broken skin-bleeding injury, or non-broken skin; internal injuries & concussions, is a debate that has gone back and forth for over half-a-century.
Keep in mind this is from only one source. This if from an Army Regulation-
AR 600-8-22, Paragraph 2-8:
a. The Purple Heart is awarded in the name of the President of the United States to any member of an Armed Force or any civilian national of the United States who, while serving under competent authority in any capacity with one of the U.S. Armed Services after 5 April 1917, has been wounded or killed, or who has died or may hereafter die after being wounded-
(1) In any action against an enemy of the United States.
(It does not specify whether it has to be director indirect action.)
(2) In any action with an opposing armed force of a foreign country in which the Armed Forces of the United States are or have been engaged.
(3) While serving with friendly foreign forces engaged in an armed conflict against an opposing armed force in which the United States is not a belligerent party.
(4) As a result of an act of any such enemy of opposing armed forces.
(5) As the result of an act of any hostile foreign force
b. While clearly an individual decoration, the Purple Heart differs from all other decorations in that an individual is not "recommended" for the decoration; rather he or she is entitled to it upon meeting specific criteria.
(1) A Purple Heart is authorized for the first wound suffered under conditions indicated above, but for each subsequent award an Oak Leaf Cluster will be awarded to be worn on the medal or ribbon. Not more than one award will be made for more than one wound or injury received at the same instant or from the same missile, force, explosion, or agent.
(2) 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 by a medical officer and records of medical treatment for wounds or injuries received in action must have been made a matter of official record.
(3) When contemplating an award of this decoration, 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 indirectcombat operations is a necessary prerequisite, but is not sole justification for award.
(4) Examples of enemy-related injuries which clearly justify award of the Purple Heart are as follows:
(a) Injury caused by enemy bullet, shrapnel, or other projectile created by enemy action.
(b) Injury caused by enemy placed mine or trap.
(c) Injury caused by enemy released chemical, biological, or nuclear agent.
(d) Injury caused by vehicle or aircraft accident resulting from enemy fire.
(e) Concussion injuries caused as a result of enemy generated explosions.
Now, from an infantryman's point of view, I totally understand and respect their personal feelings that to rate this award, one must have a bleeding wound that has broken the skin ie. bullet wound, shrapnel, ect... But the regulation for this particular award was established long ago, and hasn't changed much over the following decades since it's inception.
Any enemy inflicted wound, whether or not there is observable blood loss, merits the Purple Heart. (Invisible) brain injury caused by an enemy-inflicted concussion or blow, such as an IED explosion, that renders the serviceperson even temporarily incapacitated is a wound even though brain trauma is not is not immediately visible to the eye. Battlefield medics can, however, conduct a simple eye exam using a flashlight to determine optical (pupil dilation) response. Pupils that do not contract in response to light stimulus is indicative of a temporary or permanent brain injury/wound. More extensive brain injury/wound tests can be conducted by base hospital personnel.
A Traumatic Brain Injury is a physical injury affecting neurological structures and functions. It is often erroneously connected to Post-Traumatic Stress Disorder (PTSD). Simply put, TBI affects physiology and PTSD affects the psyche. Since TBI often does not have immediate, outward signs of injury, its impact on the health and welfare of soldiers is often overlooked as they appear normal.
In essence, when soldiers lose appendages or have a visible, bleeding wound- it is noticed and recognized as a wartime injury. When people see a veteran in a wheelchair, or using crutches, it is obvious that service member has been injured. Members of the military with TBI may not have any functional aids, and may not show outward signs of injury. That does not mean that their neurological injury is any less debilitating or severe.
Traumatic Brain Injury deserves as much recognition as any other physical wartime trauma. Its effects last as long or longer than non-neurological trauma and have the potential to affect every aspect of service members' lives. From cognitive functioning to generalized pain, neurological injury should be recognized with the Purple Heart at every level of service- from line units to division levels.
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