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Marines with concussion, mild brain injury may qualify for Purple Heart

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No one steps foot into the combat zone in hopes to be wounded. But it’s a fact that some Marines in combat will be wounded or injured as a result of enemy action, with many of the Marines being eligible for award of the Purple Heart.

A recent decision by the commandant of the Marine Corps has expanded the number of Marines who will now be eligible for the Purple Heart when they suffer a mild traumatic brain injury (mTBI) or concussion caused by enemy action.

Mild traumatic brain injuries, which can be caused by a blast or blow to the head, will now qualify for the Purple Heart if a medical officer makes a disposition that the Marine is not fit for full duty for more than 48 hours due to the persistent signs, symptoms, or findings of impairment from the concussion, provided the disposition was made within seven days of the event.

Under the Marine Corps’ revised criteria announced in Marine Administrative Message 245/11 on April 15, the Marine Corps will no longer limit award of the Purple Heart for mild traumatic brain injury or concussions solely to those cases where the Marine lost consciousness.

This change is retroactive to the start of the Global War On Terrorism, which began Sept. 11, 2001.

The two basic eligibility requirements for award of the Purple Heart established in executive order and Department of Defense regulations remain unchanged: the wound or injury must be the result of direct or indirect enemy action and must have required treatment by a medical officer at the time of the wound or injury.

However, MARADMIN 245/11 provides revised criteria by which Marine commanders will apply the second of these eligibility requirements to cases of mild traumatic brain injury where the visible signs and symptoms of the severity of the injury may not be apparent.

Mild traumatic brain injury is a physical injury, caused by the inflammation of brain tissue that can have long-lasting effects if not diagnosed and managed properly.

According to Navy Cmdr. Dave Tarantino, director for clinical programs for Marine headquarters’ health services, traumatic brain injury is divided into three categories from most to least severe: severe or penetrating, moderate and mild. Severe or penetrating traumatic brain injury and moderate traumatic brain injury have previously qualified for the Purple Heart because those injuries require evacuation to a medical treatment facility where the injury can be treated by a medical officer. However, there are no definitive medical tests to diagnose mild traumatic brain injury or determine its severity.

“In order to assess mild traumatic brain injury and concussions, corpsmen and medical officers rely on a combination of history, physical examination, clinical signs and symptoms, and other findings,” said Tarantino.

Department of Defense guidelines in effect in the combat theater for the last year require that any service member who is involved in a potentially concussive event must be placed under a 24-hour period of observation to determine if they have suffered a mild traumatic brain injury. That period of observation does not provide justification for the Purple Heart and can be extended if the member exhibits signs or symptoms of a mild traumatic brain injury.

If a medical officer determines that the Marine is not fit for full duty for a period greater than 48 hours due to signs, symptoms, or findings of impairment from the mild traumatic brain injury caused by enemy action, then the injured Marine’s command will indicate that information in the remarks section of the Marine’s Personnel Casualty Report.

In some cases, the Marine’s final disposition may not be known when the initial PCR is released. Additional medical information can be included in supplemental PCRs.

Given the natural resilience of the brain, combined with proper diagnosis and management, most Marines who have suffered from mild traumatic brain injury recover fully and experience a very high return to duty rate, explained Tarantino.

Marines, to include veteran Marines, whose medical record contains documentation that a prior mild traumatic brain injury was caused by enemy action since Sept. 11, 2001 – meeting the revised criteria – may submit a reclama through their original chain of command at the time of injury.

“The Marine Corps will continue to maintain the importance of the Purple Heart Medal at the same level as when it was first approved for combat wounded Marines during World War II,” said Lee Freund, head of Military Awards Branch at Headquarters Marine Corps.

Marines should refer to MARADMIN 245/11 for specific award criteria and reclama submission information: http://www.marines.mil/news/messages/Pages/MARADMIN245-11.aspx/.

Reclamas can be scanned and emailed to hqmc.manpower.ph_mTBI_reclama@usmc.mil (underscores before and after “mTBI”), or sent via regular post to Commandant of the Marine Corps (MMMA), Headquarters Marine Corps, 3280 Russell Road, Quantico, VA, 22134-5103.

Article by Capt. Patrick Boyce, Manpower & Reserve Affairs