A 2011 Defense Department policy change regarding mild traumatic brain injury may mean nearly 60 U.S. service members are eligible for the Purple Heart following the Jan. 8 Iran ballistic missile attack that struck two Iraqi bases housing coalition troops

Jonathan Hoffman, the chief Pentagon spokesman, did not confirm to reporters Monday if Purple Hearts would be awarded for troops injured in the Iran strike.

Hoffman said the awarding of the Purple Heart was a question for each of the individual services of the “affected members” to answer due to “standards that they all have with regard to” TBI. Hoffman said he had not received an updated timeline on how that process was playing out.

As of Jan. 30, 64 service members have been diagnosed with mild TBI stemming from the Iranian attack, according to the Pentagon. Hoffman told reporters Monday that about 60 percent of those service members have returned to duty.

In 2011, the Pentagon streamlined its policy regarding criteria for the Purple Heart to allow service members with mild TBI to be eligible for the award even if they did not lose consciousness in the attack or were not immediately treated on scene by a medical officer.

Following the new DoD guidance, the service branches followed suit updating their Purple Heart awards criteria with a retroactive date for the start of the War on Terror.

The Navy, Marine Corps, Army and Air Force each include a greater than 48-hour loss of work status as a result of a mild TBI to be eligible for the award.

Military Times has not confirmed if any of the service members injured in the Iran ballistic missile attack fall within the guidelines of the DoD’s Purple Heart policy regarding TBI.

The total number of service members who have missed work or been assigned to light duty as a result of a concussion or TBI, or the level of medical treatment provided to injured service members as a result of the Iran missile strike is unknown.

But a handful of service members have been flown out of Iraq for further evaluation and treatment.

As of Jan. 30, 39 of the 64 diagnosed service members have returned to duty, according to a Pentagon statement. All told, 38 were treated for their symptoms in Iraq, 21 were treated in Germany, eight have returned to the U.S. and nine more are scheduled to return.

“Sailors and Marines may be awarded the Purple Heart for certain mild traumatic brain injuries that were caused by enemy action” Jim Nierle, president, Navy Department Board of Decorations and Medals, said in a 2011 news release.

“If they suffered a loss of consciousness, or had to be given the disposition of ‘not fit for full duty’ by a medical officer for a period greater than 48 hours after a concussive event, they may qualify for the Purple Heart," Nierle explained in the release.

The Purple Heart is also awarded to sailors and Marines who lose consciousness as a result of a mild TBI or concussion.

The Army says the Purple Heart can be awarded for mild TBI “or concussive severe enough to cause either loss of consciousness or restriction from full duty due to persistent signs, symptoms, or clinical finding, or impaired brain functions for a period greater than 48 hours from the time of the concussive incident.”

The Army further clarifies that examples of medical treatment for a concussion that meets the standard for the Purple Heart includes, referral to neurologist or neuropsychologist, physical or occupational therapy, or restriction from duty for a period greater than 48 hours.

“Combat theater and unit command policies mandating rest periods or “down time” following incidents do not constitute qualifying treatment for concussion injuries. To qualify as medical treatment, this rest period must have been directed by a medical officer or medical professional for the individual after diagnosis of an injury as indicated,” the Army’s Purple Heart policy states.

The Air Force also includes a 48 hour loss of work requirement for airmen diagnosed with TBI or a concussion, according to the Air Force awards manual.

The Purple Heart may be awarded to airmen who experience a TBI or concussion that requires medical treatment or loss of consciousness for any duration.

“When considering award of the Purple Heart for a mild traumatic brain injury or concussion that did not result in the loss of consciousness, ensure the diagnosed mild traumatic brain injury resulted in a disposition of “not fit for full duty” by a medical officer for a period of greater than 48 hours based on persistent signs, symptoms, or findings of functional impairment resulting from the concussive event,” the Air Force awards manual detailed.

While the DoD has updated its awards policy to include some of the invisible wounds of war, the potential that nearly 60 service members may be eligible for the Purple Heart for a single attack highlights the real danger of mass casualty events for U.S. service members confronting more sophisticated enemy forces.

If approved, 64 Purple Hearts for injuries sustained from the ballistic missile strike would surpass the 47 Purple Hearts awarded to Marines from 2016 to 2018 supporting Operation Inherent Resolve — the U.S.-led mission to defeat ISIS in Iraq and Syria.

Iran’s launch of 16 missiles at the al-Asad and Erbil military bases caused more injuries than over two years of operations carried out by Marines in Syria and Iraq. Those operations included the bloody street to street battles to liberate ISIS’ former self-proclaimed capital of Raqqa, Syria, and the densely populated Mosul, Iraq.

Army Gen. Mark Milley, the Joint Chiefs chairman, described to reporters in January that Iran’s ballistic missiles were lethal 1,000- to 2,000-pound munitions “that were coming in with heavy over-pressure.”

“These things have bursting radiuses of 50 to 100 feet, and that’s just the shrapnel in the actual blast. These are very, very significant, serious weapons,” Milley said.

“And you know, if you’re within a certain range of that thing, there’s no helmet or anything else that’s going to save you,” Milley said.

The U.S. military is considering moving a Patriot missile defense battery into Iraq to protect U.S. troops from enemy ballistic missiles.

Shawn Snow is the senior reporter for Marine Corps Times and a Marine Corps veteran.

Meghann Myers is the Pentagon bureau chief at Military Times. She covers operations, policy, personnel, leadership and other issues affecting service members.

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