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A suitable compromise

I agree with soldiers who feel that awarding a Purple Heart for post-traumatic stress disorder may degrade the medal. I also agree that meeting the criteria for a new mental injury award, should one be adopted, could lead to abuses.

Here’s a compromise worth considering: a medal that recognizes any of a broad range of injuries suffered while in immediate danger.

Call it the Imminent Danger Casualty Award. Such an award would honor a range of sacrifice and duty without perpetuating the stigma associated with psychological problems.

In the Army regulation on military awards, paragraph 2-8, AR 600-8-22 lists post-traumatic stress disorder as an example of injuries or wounds “which clearly do not qualify for the award of the Purple Heart.” Other injuries that don’t qualify are those caused by “any type of accident not related to or caused by enemy action.”

If a soldier is injured in an explosion, aircraft crash or rollover, he or she is not eligible for the Purple Heart unless enemy action is involved.

Unfortunately, despite great safety efforts at every level, accidents do happen in the military that cause injuries and death. And many scars, physical or psychological, carry no visible distinction between accidental injury and enemy action.

Injuries, temporary and permanent, may affect a soldier’s quality of life, regardless of whether the source of injury was enemy action or imminent danger.

It is possible to specify what injuries would be eligible for a new type of medal by looking at the criteria for the Purple Heart. Soldiers are entitled to the Purple Heart upon meeting specific criteria. Those criteria require treatment by a medical officer and official record of medical treatment.

If awarded, the new medal would recognize a soldier’s sacrifice of personal health for service in a combat environment.

On another front in the effort to recognize a range of wounds, Congress is considering expanding eligibility for Traumatic Servicemembers’ Group Life Insurance compensation to include even noncombat injuries.

PTSD and traumatic brain injury can have effects that are difficult to assign perfectly into award criteria or even to diagnose.

These diagnoses have become the signature injuries for operations Iraqi Freedom and Enduring Freedom. Defense Department and civilian health care providers are quickly addressing their impact on soldiers’ functional performance, as well as the challenges for intervention and rehabilitation. The perceived or actual stigma associated with PTSD or TBI can thwart efforts to seek help.

An award for PTSD might eliminate the stigma associated with this disorder, but at what cost? Some soldiers may feel their privacy is compromised when required to wear such a decoration.

Perhaps their PTSD is temporary, and wearing a PTSD award indefinitely could be viewed as a scarlet letter by those with preconceived notions about mental disorders.

The Purple Heart does not identify the actual injury, and neither should a decoration or award for imminent danger injuries. By adopting a more broadly defined award, a soldier can proudly wear it and decide what he wants to disclose if asked.

Such an award, ambiguous enough to minimize stigma while still honoring soldiers with injuries sustained while in imminent danger, is a suitable alternative to the Purple Heart medal and should be considered.

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The writer is is the officer in charge of the Mental Fitness Program while deployed in Iraq with the 528th Combat Stress Control Medical Detachment from Fort Bragg, N.C. These views are those of the writer and not necessarily the views of the Defense Department or the Army.

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