Soldiers With Brain Trauma Denied Purple Hearts, Adding Insult to Injury

Soldiers have had to battle for months and sometimes years to prove that these wounds, 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 e-mails 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 e-mails 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.

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

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.

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 e-mailed 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."