The Purple Heart is frequently described as the military's oldest medal. Gen. George Washington created it in 1782 to recognize meritorious service -- basically bravery in combat -- but it soon fell into disuse. In 1932, to mark the bicentennial of Washington's birth, Gen. Douglas MacArthur spearheaded an effort to revive the medal. It was designed to commemorate bravery, but also recognized soldiers with wounds.
Purple Hearts were initially awarded to recognized meritorious service, but during World War II, the medal was changed into a recognition of combat injuries and deaths.
Later, during World War II, the medal was changed into a recognition of combat injuries and deaths. Over time, the military has further modified the award, adding different types of injuries and different types of combat. For instance, soldiers wounded in acts of terrorism now qualify for the Purple Heart, as do soldiers injured in friendly fire.
An individual soldier can apply for a Purple Heart, but more commonly, command superiors submit an awards package demonstrating that the soldier has met all criteria for the award. A superior officer can deny a Purple Heart, but such denials usually require review and then concurrence by a General-level officer. The process can differ by branch and by theater of operations.
Today, the military has awarded an estimated 1.7 million Purple Hearts to soldiers, sailors, Marines and airmen. Unlike other military awards, the Purple Heart is an entitlement -- it does not depend upon the recommendation of a superior officer. Instead, the military gives it to those troops that meet basic criteria. In general, the wound must have occurred during hostilities and it must have required treatment that was documented by a medical officer.
The exact number of Purple Hearts awarded is not tracked by The Pentagon, nor is the type of injury a soldier has suffered. Thus, it is not clear how many soldiers have received the Purple Heart for mild traumatic brain injuries, or how many applied but were denied. Soldiers who receive a denial must first appeal through their chain of command. Beyond that, a soldier can appeal through the Army Human Resources Command, and depending on the time of the injury, different boards may review an appeal before making a final decision. This process can take months, even years.
Below, a timeline of the Purple Heart through history.
Aug. 7, 1782: George Washington issues order to create the Badge of Military Merit to recognize meritorious action. Only a handful of soldiers are known to have received it.
Feb. 22, 1932: Gen. Douglas MacArthur revives the Purple Heart on the bicentennial of Washington’s birthday. The medal is primarily designed to recognize meritorious service. The Purple Heart is also given to soldiers wounded or killed in battle. MacArthur is given Purple Heart No. 1.
Apr. 28, 1942: Military allows posthumous award of Purple Heart after heavy loss of life at Pearl Harbor.
Sept. 4, 1942: War Department designates the Purple Heart exclusively for wounds or deaths in combat.
Aug. 2, 1943: John F. Kennedy was wounded in action that resulted in a Purple Heart. He is the only U.S. president to have received the honor.
Aug. 15, 1944: Maj. Gen. Robert T. Frederick is awarded his eighth Purple Heart. That is believed to be the record for any soldier in a single conflict.
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Journalist Ernie Pyle shows his book Here is Your War to actor Burgess Meredith on June 11, 1944.
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1950s: Controversy over award of Purple Heart for frostbite. Soldiers and sailors were not given the medal for frostbite, while aviators awarded it. Eventually, the military ruled out frostbite as an eligible injury
April 1983: War correspondent Ernie Pyle was awarded the Purple Heart. Civilians are no longer given the Purple Heart. Pyle, who wrote for the Scripps Howard news service, was killed in April 1945.
Feb. 23, 1984: Ronald Reagan signs an executive order allowing the Purple Heart to be issued for injuries suffered as a result of terrorism.
Dec. 20, 1989: A U.S. soldier suffers heat stroke during an invasion in Panama and is awarded Purple Heart. The outcry from veterans groups leads the Army to exclude heat stroke as eligible injury.
1996: Regulations are amended to allow prisoners of war to receive the Purple Heart.
May 2008: Brig. Gen. Joseph Caravalho issues a policy which suggests that "minimum medical treatment" is necessary to award the Purple Heart to soldiers with mild traumatic brain injury. Such language is not part of official Army regulations.
That same month, an Army psychologist suggests that the Purple Heart be awarded to soldiers suffering from post traumatic stress disorder, or PTSD. A Pentagon panel later nixes the idea, declaring that PTSD is a "secondary effect" to enemy action which wounds a soldier.
Brig. Gen. Joseph Caravalho
Jan. 2009: Recognize the Sacrifice, a website, is founded to help soldiers with mild traumatic brain injury apply for the Purple Heart.