September 9, 2010
Anna Christopher, NPR




A continuing NPR News and ProPublica investigation into the treatment of mild traumatic brain injury by the military has found that the Army routinely denies Purple Hearts to soldiers suffering mild TBI, despite regulations that clearly entitle such recognition. In interviews with soldiers and military leaders, and by obtaining internal Army emails, NPR correspondent Daniel Zwerdling and T. Christian Miller of ProPublica found evidence that some Army commanders still don’t consider mild TBI a real injury. Wounded soldiers have to battle to prove they earned the medal, and even then are turned down despite well-documented blast wounds that have caused mild TBI, also known as concussion.

The report is airing in two parts today on NPR's Morning Edition and All Things Considered (check for local stations and broadcast times at Complete details are at and Zwerdling and Miller are also reporting their findings in a story produced by the PBS series Frontline airing tonight on The NewsHour and in Stars and Stripes, an editorially independent daily newspaper and website distributed to troops and U.S. military bases.

Zwerdling and Miller interviewed soldiers across the country – all were injured in explosions, all were diagnosed with mild TBI and all are still waiting for their Purple Heart. Sgt. Derrick Junge, injured when a rocket slammed into his trailer in Baghdad in January 2009, was denied a Purple Heart. Today, he has trouble with short term memory and other lingering effects of mild TBI. He tells NPR and ProPublica: "As a soldier, you're expected to be a certain level of tough. ...If it's not a visible injury, it's kind of looked at as a non-injury. For soldiers, it's like, are you a puss?"

Army regulations state that injuries that "clearly justify" the Purple Heart include "concussion injuries caused as a result of enemy generated explosions." Military spokesmen told Zwerdling and Miller that the Army does not keep statistics on the number of soldiers who have received Purple Hearts for TBIs or been denied. The Army does say that more than 25,000 soldiers have been awarded Purple Hearts in Iraq and Afghanistan for all types of injuries; official military statistics say that almost 90,000 Army soldiers have suffered TBI, and previous NPR and ProPublica investigations have found evidence that tens of thousands more have gone undiagnosed and untreated.

NPR and ProPublica obtained a recording, which has not been reported until now, in which a senior Army medical researcher told a conference of brain specialists last year that senior commanders in Iraq did not want many soldiers with mild TBIs to receive Purple Hearts. "There was a push by the higher level commands to not be seen to be giving these out for just 'any old injury,'" Col. Rodney Coldren, of the Uniformed Service University of the Health Sciences, told the annual conference of the National Academy of Neuropsychology.

NPR and ProPublica also uncovered another memo – previously unreported until now – issued in 2008 by the top medical commander in Iraq restricting the circumstances under which soldiers with mild traumatic brain injury could receive Purple Hearts. Brig. Gen. Joseph Caravalho, then serving as the corps surgeon in Iraq, wrote, "In many cases, concussions with minimum medical intervention will not warrant this award." That sets a much tougher standard for mild TBIs than other injuries, since official Army regulations on Military Awards don’t say anything about the level of treatment required after any other type of wound to merit a Purple Heart.

Zwerdling and Miller asked Gen. Peter Chiarelli about the 2008 order issued by Caravalho; he said he had not been previously aware of it, and has asked Army lawyers to review the policy. Chiarelli told NPR and ProPublica: "There still are some commanders, okay, who – and there may be some doctors, too – who don't feel that a concussion should entitle somebody for a Purple Heart. But we have far more commanders that understand that the concussion is a real injury today then we had in 2004 and 2005."

All excerpts must be credited to NPR News and Propublica. Television usage must include on-screen chyron to NPR News and ProPublica, with both organizations' logos.

The NPR News Investigative Unit crosses all news desks and programs to build upon, and strengthen the commitment to, NPR's established investigative work. The team has been reporting extensively on the mining accident at Upper Big Branch in West Virginia and the continuing oil spill and clean-up in the Gulf of Mexico. Other recent stories include the retelling of little-known Vietnam-era story of a dramatic humanitarian mission undertaken by the U.S. Navy destroyer USS Kirk and the possibility of Mexico's drug war being a rigged fight.