Veterans who suffer from PTSD now eligible for Purple Heart

Until recently, soldiers were presented with a Purple Heart medal as an acknowledgement of physical wounds received in action. It's often referred to as the medal no soldier wants, but once received, he is proud to wear it.

During the past several months two important items of interest pertaining to the Purple Heart have come to the forefront and deserve discussion here. The first concerns eligibility for consideration to be given the medal. Much has been made of returning GIs who suffered battlefield concussions and as a result were further diagnosed with Post Traumatic Stress Disorder, more commonly known as PTSD.

In the last several years, discussions were had to allow granting a Purple Heart to those who suffer from PTSD. This was not taken lightly by many veterans, who felt the medal should be given only to those who suffer physical wounds. The medal itself is considered to be the oldest U.S. military decoration, having been developed by Gen. George Washington during the Revolutionary War.

Originally called the Badge of Military Merit, it was given to soldiers for instances of unusual gallantry, extraordinary fidelity and essential service. At the time it was not specifically given to those who were wounded, although it transitioned into that over the years. Now the Army has decided to also give the medal to those who suffer battlefield concussions even if they do not incur physical wounds.

Recent studies of brain trauma have convinced the Army to revise what constitutes a concussion. Specific symptoms are required in order to be considered for the medal, and the Army is setting a high standard. When both diagnostic and treatment factors are present and documented by a medical officer in a soldier's record, the odds are higher that a Purple Heart could be awarded.

Now, it seems, it may be that however severe or limited their wounds, be they physical or through concussions, more soldiers could live longer if they receive a Purple Heart. The Department of Veterans Affairs (VA) concluded a study that found that aging veterans who received the medal show decreased mortality rates compared with those who did not get a Purple Heart. Further, the study showed that war-wounded veterans who survive into later life -- especially those who do not develop Post Traumatic Stress Disorder -- may provide valuable clues as to the factors that lead to resilience to combat stress.

The question could arise, can veterans who suffered concussions before the new ruling now go back to the Army and apply for the medal? Dr. Ramanujam Komanduri, chief of staff for the VA Southern Nevada Healthcare System in Las Vegas, was asked how veterans might go about applying for a Purple Heart after they have left active duty and enrolled in the VA system.

He said the VA is concentrating on "the backlog of benefits and claims. I have not seen where VA documentation can be 'taken back' to the military. It's a possibility. If the military would accept that, I don't know." He said there are cases in which soldiers receive concussions and don't report it. "They did not want to leave their buddies. They did not want to receive recognition. I don't know if the military would (later) reconsider a medal."

More than 10,000 veterans of World War II and the Korean War were studied by VA researchers. Tim Kimbrell is the lead author of the study, which can be found in the journal "Depression and Anxiety" at adaa.org.

A physician with the Center for Mental Health and Outcomes Research based at the VA in Arkansas, Kimbrell said, "Among the older veterans we studied, those with Purple Heart citations had half the mortality rate of those without Purple Heart citations."

The findings may be good news to many elderly veterans who have given thought to just how much longer their life spans may be. Whether the medal holders have chronic PTSD or not, they were about twice as likely to still be alive after some 10 years of follow-up, compared to those with no Purple Heart and no PTSD. The study included veterans who were 65 or older in the late 1990s. It tracked their survival through 2008.

Many older veterans will be affected by this study, one way or another. It is estimated that more than 1 million servicemembers received a Purple Heart in WWII and nearly 119,000 in the Korean War. In recent years, researchers with the VA and the Department of Defense have sought insight into the medical factors that enable some servicemembers to not develop PTSD after traumatic events. The authors of the recent study say Purple Heart holders who survive long past their war experience without PTSD may be the ideal population on which to focus such research.

Among Purple Heart recipients, those with PTSD had slightly lower mortality rates than those without PTSD. Kimbrell and his colleagues suggest this may be due to what they call "early attrition." Those who had been physically injured in WWII or Korea and suffered PTSD may have been less likely to survive until age 65 in the first place. But the Purple Heart-PTSD group in the study may have been exceptionally healthy veterans to begin with. Ongoing studies are needed to certify any results. But Komanduri agrees with the possibility that such veterans were probably more healthy at the start. "Maybe those soldiers are more resilient to begin with," he said. He said he has examined former POWs who received some of the most terrible treatment imaginable, yet they were relatively healthy because "they were much more optimistic people to begin with."

For details on soldier eligibility for a Purple Heart due to traumatic brain injury, go to www.hrc.army.mil or call the Army Human Resources Command Center at 888-276-9472.

Journalist and author Chuck N. Baker is an Army veteran of the Vietnam War and a recipient of the Purple Heart. He is the managing editor of Nevada's Veterans Reporter newspaper and the host of the "Veterans Reporter Radio Show" on KLAV (1230 AM) from 8-9 p.m. Thursdays.