More Marines with concussion or mild brain injury qualify for Purple Heart

QUANTICO, Va. - A decision in April by the commandant of the Marine Corps will allow more Marines and Sailors who served with Marine commands in combat to receive the Purple Heart for mild traumatic brain injuries or concussions.

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

According to Lee Freund, head of Military Awards Branch at Headquarters Marine Corps, the purpose of the new MARADMIN is, “To get the word out on the commandant’s decision to revise the previous Purple Heart criteria for mTBI...[and] to inform Marines and Sailors serving with Marine commands in combat of the basic rules for determining Purple Heart eligibility for all types of wounds or injuries.”

MTBI/concussions, 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.

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 mTBI/concussion where the visible signs and symptoms of the severity of the injury may not be apparent.

“Very mild concussions that resolve quickly without prolonged impairment will not qualify for the Purple Heart,” said Freund.

Prior to release of the MARADMIN, an mTBI/concussion only qualified for the Purple Heart if there had been an observed loss of consciousness. As explained in the message, recent medical research has shown that an mTBI/concussion without a loss of consciousness can result in more serious brain impairment than earlier believed. Symptoms of mTBI/concussion can include headaches, intolerance of sunlight, temporary amnesia and decreased cognitive functions.

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

“We’ve learned a lot more about mTBI and concussions during the last six months,” said Freund.

According to 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 TBI and moderate TBI 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 mTBI or determine its severity.

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

DoD 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 an mTBI/concussion. That period of observation can be extended if the member exhibits signs or symptoms of an mTBI/concussion. However, evaluation by a medical officer or assignment to administrative light duty solely for the purpose of observation or screening will not be considered justification for the Purple Heart.

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 mTBI/concussion 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 mTBI/concussion recover fully and experience a very high return to duty rate, explained Tarantino.

Marines, including veteran Marines, whose medical record contains documentation that a prior mTBI/concussion 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 Freund.

Marines should refer to MARADMIN 245/11 for specific award criteria and reclama submission information.

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, Headquarters Marine Corps, 3280 Russell Road, Quantico, Va, 22134-5103.

Editor’s note:  Boyce is the Deputy PAO M&RA