Pentagon: No Purple Hearts for PTSD

Stress disorder tough to quantify, panel decides

The Purple Heart is given to those in the military who are wounded or killed by enemy action.

The Pentagon has decided that it will not award the Purple Heart, the hallowed medal given to those wounded or killed by enemy action, to war veterans who suffer from post-traumatic stress disorder because it is not a physical wound.

The decision ends the hope of Iraq and Afghanistan veterans who have the condition and had hoped that the Purple Hearts could honor their sacrifice and help remove some of the stigma associated with the condition.

The disorder, which may go unrecognized for months or years, can include recurring nightmares, uncontrolled rage and, sometimes, severe depression and suicide. Soldiers grappling with PTSD are often unable to hold down jobs.

In May, Defense Secretary Robert Gates said awarding Purple Hearts to such service members was "clearly something that needs to be looked at," after he toured a mental health center at Fort Bliss, Texas.

But a Pentagon advisory group decided against the award because, it said, the condition had not been intentionally caused by enemy action, like a bomb or bullet, and because it remained difficult to diagnose and quantify.

"Historically, the Purple Heart has never been awarded for mental disorders or psychological conditions resulting from witnessing or experiencing traumatic combat events," Eileen Lainez, a Pentagon spokeswoman, said in a statement on Tuesday. "Current medical knowledge and technologies do not establish PTSD as objectively and routinely as would be required for this award at this time."

One in five service members, or at least 300,000, suffer from post-traumatic stress disorder or major depression, according to a Rand Corp. study in 2008. For some soldiers suffering from the disorder, the distinction between blood and no blood in an injury fails to recognize the depths of their mental scars. A modern war - one fought without safe havens and with the benefit of improved armor - calls for a new definition of injuries, some veterans say.

Kevin Owsley, 47, served in the Ohio National Guard in 2004 as a gunner on a Humvee and who is being treated for PTSD and traumatic brain injury, said he disagreed with the Pentagon's ruling. Unable to hold a job, Owsley supports his family on disability payments. Just this week he told his Veterans Affairs doctor he was fighting back suicidal impulses, something he has struggled with since his return.

"You relive it every night and every day," he said. "You dream about it. You can see it, taste it, see people getting killed constantly over and over."

"It is a soldier's injury," he said, angrily, in a telephone interview yesterday.

But many soldiers do not feel that way. In online debates and interviews they expressed concern that the Purple Heart would be awarded to soldiers who faked symptoms to avoid combat or receive a higher disability rating from the Department of Veterans Affairs.

"I'm glad they finally got something right," said Jeremy Rausch, an Army staff sergeant who saw some of the Iraq War's fiercest fighting in Adhamiya in 2006 and 2007. "PTSD can be serious, but there is absolutely no way to prove that someone truly is suffering from it or faking it." The Purple Heart in its modern form was established by General Douglas MacArthur in 1932. Some 1.7 millions service members have received the medal.

The medal entitles service members to enhanced benefits, including exemptions from co-payments for hospital and outpatient care and gives them higher priority in scheduling appointments.

The Pentagon said that it could revisit the issue.

A Pentagon-supported service group, the Military Order of the Purple Heart, has strongly opposed expanding the definition to include psychological symptoms, saying it would "debase" the honor.

"Would you award it to anyone who suffered the effects of chemicals or for other diseases and illnesses," John E. Bircher III, director of public relations for the group, said yesterday. "How far do you want to take it?"

Post traumatic stress disorder was first identified during the Vietnam War, and has gradually been accepted as a serious psychological problem for some who experience violence and fear.

Dr. Barbara V. Romberg, a psychologist in Bethesda, Md., and founder of Give an Hour, which offers mental health services to troops and their families, said she and many other psychologists believed the discussion of Purple Hearts had brought more attention to post-traumatic stress disorder and the seriousness of psychological wounds suffered on the battlefield.