The Purple Heart: Background and Issues for Congress

August 31, 2015 (R42704)
Jump to Main Text of Report

Introduction

Requirements for military awards and decorations can change over time. New events and changes in military, political, or social conditions can generate debate over who is eligible for various military awards. These changes tend to be controversial, especially with veterans groups. Congress considered several pieces of legislation that would change who would be eligible to receive the Purple Heart, and under what conditions.

The wars in Iraq and Afghanistan have greatly increased the number of servicemembers receiving the Purple Heart award1 as well as the potential conditions under which they receive the award. Increasingly acknowledged conditions, such as traumatic brain injuries (TBI) and post-traumatic stress disorder (PTSD), as well as accidents and other events while deployed, bring up new questions as to when a servicemember deserves a Purple Heart. The July 17, 2015, shooting of servicemembers at a Marine recruiting office and a Naval reserve center in Chattanooga, TN, has again prompted questions about applying the Purple Heart to terrorist attacks versus criminal acts.

Veterans groups often voice their views when Congress or the President proposes making changes to expand eligibility for the Purple Heart. These groups argue, for example, that a servicemember who acquires PTSD may not always deserve the same recognition as a servicemember killed or wounded in direct combat.2 While others contend that these medical conditions can debilitate servicemembers just as much as physical injuries and can have lasting effects on servicemembers' lives. Determining which actions and events make a servicemember qualified for receiving a Purple Heart, and whether expanding eligibility does a disservice to those who have already earned the award, are contentious elements of this debate.

Although Congress has traditionally left many military award requirements to the executive branch, the Constitution does allow Congress to act in this area, and events have prompted changes regarding eligibility for the Purple Heart.3 On December 19, 2014, Congress passed the National Defense Authorization Act (NDAA) for FY2015. Section 571 of the NDAA for FY2015 expanded eligibility by redefining what should be considered an attack by a "foreign terrorist organization" for purposes of determining eligibility for the Purple Heart. As a result, servicemembers wounded and killed in the 2009 shootings in Little Rock, AR, and at Fort Hood, TX, were recently awarded Purple Hearts.

Congressional offices often receive questions about Purple Heart eligibility from constituents, especially when eligibility rules change. The number of these questions is likely to increase as servicemembers return from conflicts around the world and if eligibility requirements are again changed. This report will examine the history of the Purple Heart and changes in eligibility over time as well as current issues facing Congress.

Original Conception

In 1782, George Washington created the Badge of Military Merit to reward "any singularly meritorious action" displayed by a soldier, non-commissioned officer, or officer in the Continental Army.4 This award was intended to encourage gallantry and fidelity among soldiers, and would later become known as the Purple Heart.

The Badge of Military Merit was designed as a purple heart of cloth edged with a narrow lace.5 Records are incomplete and researchers debate how many soldiers received this award. According to Military Order of the Purple Heart, three soldiers from Connecticut were the first to receive the Badge of Military Merit during the American Revolutionary War. All three were noncommissioned officers and the only recipients who received the award from General Washington. The soldiers were Sergeant William Brown, 5th Connecticut Regiment of the Connecticut Line on May 3, 1783; Sergeant Elijah Churchill, 2nd Continental Light Dragoons on May 3, 1783; and Sergeant Daniel Bissell, 2nd Connecticut Regiment of the Connecticut Line, on June 10, 1783.6 However, the Badge of Military Merit fell into disuse shortly after its conception.

History of the Purple Heart

The Badge of Military Merit was not seriously considered again until General Douglas MacArthur (then Army Chief of Staff) revived the award on February 22, 1932, the 200th anniversary of George Washington's birth.7

This award, renamed the "Purple Heart," was redesigned to its modern appearance: a purple heart-shaped medal with bronze border and George Washington's coat of arms between two green spray leaves.8 General MacArthur also redefined the eligibility requirements to those who received Meritorious Service Citation certificates from World War I or those authorized to wear wound chevrons by Army Regulation (AR) 600-8-22, Military Awards.9 It was at this point that the Purple Heart became focused on soldiers killed and wounded in combat, rather than "any singularly meritorious act."

In 1942, President Roosevelt extended the Purple Heart award, which to this point was exclusively an Army award, to Navy, Marine Corps, and Coast Guard members serving in World War II.10 In 1952, President Truman retroactively awarded Purple Hearts to personnel in the Navy, Marine Corps, and Coast Guard that qualified after April 5, 1917, thus including World War I veterans of all services.11

From 1962 until 1998, eligibility for the Purple Hearts was changed on several occasions. President Kennedy authorized Purple Hearts to all servicemembers, and civilians serving with the Armed Forces, who were engaged in armed conflict against an opposing military or hostile foreign force.12 This expansion was written to permit U.S. servicemembers, and the civilians that accompanied them, who were killed or wounded in Vietnam to receive the Purple Heart, as many of those servicemembers were officially considered advisors to the Republic of Vietnam, rather than combatants.13

Purple Heart eligibility was expanded again by President Reagan to include military personnel and government civilians killed or wounded in international terrorist attacks after March 28, 1973, or those serving in peacekeeping operations outside of the United States.14 This expansion was in response to increased terrorist attacks against U.S. servicemembers abroad, namely the Marine Corps Barracks bombing in Beirut, Lebanon, in 1983.15

The National Defense Authorization Act for Fiscal Year 1996 expanded eligibility to prisoners of war injured or wounded in captivity prior to 1962, a group of servicemembers previously not covered for Purple Heart eligibility by President Kennedy's executive order.16 In 1997, President Clinton signed the National Defense Authorization Act for Fiscal Year 1998, which limited future awards of the Purple Heart to military personnel.17 It has since remained a military-only award.

Current Eligibility

Currently, the Purple Heart is authorized for any member of the U.S. Armed Forces who has been wounded or died from wounds sustained after April 5, 1917, under one of the following conditions:18

(1) In action against an enemy of the United States.

(2) In action against an opposing armed force of a foreign country in which the U. S. Armed Forces are or have been engaged.

(3) While serving with friendly foreign forces engaged in armed conflict against an opposing armed force in which the United States is not a belligerent party.

(4) As a result of an act of any such enemy or opposing armed forces.

(5) As the result of an act of any hostile foreign force.

(6) After March 28, 1973, as a result of an international terrorist attack against the United States or a foreign nation friendly to the United States, recognized as such an attack for purposes of award of the PH by the Secretary of the Military Department concerned, or jointly by the Secretaries of the Military Departments concerned if members from more than one Military Department are wounded in the attack. The Secretary of the Military Department concerned shall notify the Under Secretary for Personnel and Readiness USD(P&R) prior to awarding the PH for an international terrorist attack that occurs in the United States or its territories.

(7) After March 28, 1973, as a result of military operations while serving outside the territory of the United States as part of a peacekeeping force.

(8) On or after December 7, 1941, a service member who is killed or wounded in action as the result of action by friendly weapon fire while directly engaged in combat, other than as a result of an act of an enemy of the United States, unless (in the case of a wound) the wound is the result of willful misconduct of the member (in accordance with section 1129 of Title 10, U.S. Code).

(9) Before April 25, 1962, while held as a prisoner of war (or while being taken captive) in the same manner as a former prisoner of war who is wounded on or after that date while held as prisoner of war (in accordance with section 521 of Public Law (P.L.) 104-106 Section 521.19

(10) On or after December 7, 1941, to a Service member who is killed or dies while in captivity as a prisoner of war (POW) under circumstances establishing eligibility for the POW medal pursuant to section 1128 of Title 10, U.S. Code, and section 15, Enclosure 3, Volume 2 of the Manual of Military Decorations and Awards, unless compelling evidence is presented that shows that the member's death was not the result of enemy action.

(11) After September 11, 2001, pursuant to section 1129a of Title 10, U.S. Code, to a Service member on active duty who is killed or wounded in an attack by a foreign terrorist organizations in circumstances where the death or wound is the result of an attack targeted on the member due to such member's status as a member of the armed forces. An attack by an individual or entity shall be considered to be a foreign terrorist attack if the individual or entity was in communication with the foreign terrorist organization before the attack and the attack was inspired or motivated by the foreign terrorist organization.

An award is not authorized if the death or wound was the result of the willful misconduct of the member.

To assist in making a PH determination pursuant to section 1129a of Title 10, U.S. Code, the Military Department Secretary concerned may request an intelligence assessment from the Defense Intelligence Agencies' Defense Combating Terrorism Center (DCTC). The DCTC assessment of potential foreign terrorist attacks by an individual or entity will assess whether the individual or entity was in communication with the foreign terrorist organization before the attack and if the attack was inspired or motivated by the foreign terrorist organization. The assessment shall include supporting citations and rationale.

A wound qualifying for a Purple Heart must have required treatment, not just examination, by a military medical officer or other medical professional. That treatment must be noted in the servicemember's medical record. If treatment was given by a medical professional who was not a medical officer, a medical officer has to certify that the injury would have required treatment from a medical officer had one been available.20

For deceased servicemembers, the Purple Heart may be given to the representatives of the deceased as the individual Service Secretary considers appropriate.21

Servicemembers can be awarded multiple Purple Hearts for separate incidents. The servicemember receives the Purple Heart medal for the first award. Subsequent awards are indicated with oak leaf clusters or 5/16 inch service stars, depending on the rules of the recipient's service.22 Purple Hearts may not be awarded to foreign military personnel.

Issues for Congress

Although the decision to award medals and other military decorations traditionally rests with the executive branch, Congress has been expanding its role in this area in recent decades, exercising its constitutional power "to make rules for the government and regulation of the land and naval forces."23 Previously, Congress took the lead and adjusted Purple Heart eligibility in both the National Defense Authorization Act for Fiscal Year 1996 and the National Defense Authorization Act for Fiscal Year 1998.24 In response to more recent events, Congress passed a provision in the NDAA for FY2015 that again expands the Purple Heart's eligibility requirements.

Domestic Terrorism and the FY2015 NDAA (P.L. 113-291)

On June 1, 2009, a man who was allegedly angry over the killing of Muslims in Iraq and Afghanistan opened fire on two U.S. Army soldiers near a recruiting station in Little Rock, AR, killing one and wounding the other.25 On November 5, 2009, an Army major opened fire at Ft. Hood, TX, killing 13 and wounding 29, many of them servicemembers. Both men were charged with murder and other crimes.26

Federal and local law enforcement authorities initially considered these acts to be crimes, and the Defense Department reports the Fort Hood shooting as "workplace violence," not acts perpetrated by an enemy or hostile force.27 Subsequently, by labeling these shootings criminal acts, those killed or wounded did not qualify for Purple Hearts.28 However, some believe these acts should be viewed as acts of war or domestic terrorism because they involved Muslim perpetrators angered over U.S. actions in Iraq and Afghanistan.29

Section 571 of the NDAA for FY2015 (P.L. 113-291) expanded the eligibility for the Purple Heart by redefining what should be considered an attack by a "foreign terrorist organization" for purposes of determining eligibility for the Purple Heart. The law states that an event should be considered an attack by a foreign terrorist organization if the perpetrator of the attack "was in communication with the foreign terrorist organization before the attack" and "the attack was inspired or motivated by the foreign terrorist organization."

Still some are opposed to awarding the Purple Heart for terrorist acts that were initially deemed "workplace violence" by the Department of Defense (DOD) or a crime, and not earned on a battlefield.30 This act arguably sets a precedent for the future and could make Purple Heart eligibility more subjective, allowing public sentiment to determine what events are worthy of a Purple Heart.

On April 10, 2015, Army Secretary John McHugh and Army Lt. General Sean MacFarland, 3rd Corps and Fort Hood commanding general, presented Purple Hearts to the families of the 10 servicemembers killed and to the 26 servicemembers wounded during the attack.31 Defense of Freedom Medals were also awarded to DOD civilians killed and wounded during the attack. In a memorandum, Secretary McHugh directed the Army to "expedite certain other benefits for which soldiers receiving the Purple Heart are traditionally eligible."32

In addition to the victims of the Fort Hood shooting, the two victims of the June 2009, shooting at a recruiting station in Little Rock, Arkansas, received Purple Hearts on July 1, 2015. Army Pvt. William Andrew "Andy" Long was killed and Army Pvt. Quinton Ezeagwula was wounded in that attack by Abdulhakim Muhammad, who was convicted and sentenced to life in prison without the possibility of parole.33

NDAA for FY2016 (H.R. 1735)

Encouraged by the expanded eligibility provision in the NDAA for FY2015, legislation was introduced during the 114th Congress to award Purple Hearts to other military victims of domestic terrorism.34 Section 583 of the Housed-passed version of H.R. 1735, the NDAA for FY2016, would award the Purple Heart to servicemembers who were victims of the April 19, 1995, Oklahoma City, Oklahoma bombing. Supporters for awarding the Purple Heart to the victims of the Oklahoma City bombing refer to the FY2015 NDAA as precedent for these victims. However, critics contend that the bombing was an act of domestic terrorism and does not meet the current eligibility requirements of the assailant being inspired by or motivated by an international terrorist organization.

Chattanooga Shooting on July 16, 2015

The recent shooting on July 16, 2015, by Muhammad Youssef Abdulazeez, at a Marine Corps recruiting center and Naval Reserve Center in Chattanooga, TN, has again raised congressional interest regarding the eligibility for the Purple Heart for servicemembers killed and wounded during an attack inspired by or motivated by international terrorist organizations. Four marines were killed during the rampage and the lone sailor later died from his injuries.35 The FBI investigation is ongoing but the Marine Corps has prepared nomination packages for the four marines killed while the Navy has deferred until the conclusion of the investigation.36

Traumatic Brain Injuries, Post-Traumatic Stress Disorder, and the Purple Heart

The large number of veterans with invisible wounds37 returning from Iraq and Afghanistan has the Department of Defense (DOD) reevaluating Purple Heart eligibility for traumatic brain injuries (TBI) and mental conditions such as post-traumatic stress disorder (PTSD).38 DOD considers some TBIs eligible for the Purple Heart, as many of those injuries can be diagnosed using brain scans and other objective medical tests.39 However, there is continued debate on the validity of mental conditions, such as PTSD, being a part of the appropriate criteria for the Purple Heart. Congress, as well as various executive agencies and departments, is funding and conducting studies regarding PTSD.40 The National Alliance on Mental Illness, a national grassroots advocacy group representing families and people affected by mental illness, is advocating that the Purple Heart be awarded for psychological wounds including PTSD to eliminate stigma and encourage servicemembers to seek care.41

At this time, DOD does not consider servicemembers with PTSD eligible for the Purple Heart. Army Regulation 600-8-22 allows "concussion injuries caused as a result of enemy generated explosions" but specifically disqualifies post-traumatic stress disorders.42 Army guidance emphasizes "the degree to which the enemy caused the injury" when determining eligibility and places PTSD in a column of non-eligible injuries.43 The Marine Corps defines PTSD as a "severe combat stress injury" and says that combat stress injuries are "not directly caused by the enemy's intentional use of an outside force or agent," and thus do not qualify.44

However, servicemembers are divided on this issue. Some members believe that mental injuries such as PTSD should be eligible for the Purple Heart, while others believe that it would dishonor those who have received Purple Hearts for physical injuries.45 Some veterans from the Military Order of the Purple Heart and Veterans of Foreign Wars are resistant to accepting PTSD as grounds for eligibility. A representative of The Military Order of the Purple Heart said in a recent statement, "We believe strongly in and support the criteria that the wound or death should be sustained in combat at the hands of the enemies of the United States."46 In addition, the national spokesman for the Veterans of Foreign Wars, Joseph E. Davis, said, "Medals aren't awarded for illness or disease, but for 'achievement and valor.'"47

Timeline of Purple Heart Eligibility

August 7, 1782: George Washington creates the Badge of Military Merit. Awarded to several Continental soldiers but it quickly falls from use.

February 22, 1932: Army Chief of Staff General Douglas MacArthur revives the Badge of Military Merit as an Army award, renamed "the Purple Heart," and retroactively awarded to wounded WWI veterans.

December 3, 1942: Executive Order 9277 - President Franklin Roosevelt expands Purple Heart eligibility to include U.S. Navy, Marine Corps, and Coast Guard. Retroactively awards Purple Hearts to December 6, 1941.

November 12, 1952: Executive Order 10409 - President Truman retroactively awards Purple Hearts to U.S. Navy, Marine Corps, and Coast Guard veterans after April 5, 1917.

April 25, 1962: Executive Order 11016 - President Kennedy extends eligibility to civilians serving with military forces.

February 23, 1984: Executive Order 12464 - President Reagan awards Purple Hearts to those killed and wounded in terrorist attacks after March 28, 1973, or on peacekeeping missions outside the United States.

February 10, 1996: National Defense Authorization Act for Fiscal Year 1996 (Sec. 521, 104-106) includes "prisoners of war wounded before April 25, 1962, while held as a prisoner of war (or while being taken captive) in the same manner as a former prisoner of war who is wounded on or after that date while held as a prisoner of war (or while being taken captive)."

November 18, 1997: National Defense Authorization Act for Fiscal Year 1998 (Sec. 571, P.L. 105-85) limits future Purple Heart awards to members of the Armed Forces.

October 17, 2006: National Defense Authorization Act for Fiscal Year 2007 (Sec. 556, P.L. 109-364) includes prisoners of war captured after December 7, 1941.

April 30, 2008: Purple Heart Family Equity Act of 2007 (P.L. 110-207) revises the congressional charter of the Military Order of the Purple Heart to authorize associate membership for the spouse and siblings of a recipient of the Purple Heart medal.

December 19, 2014: National Defense Authorization Act for Fiscal Year 2015 (Sec. 571, P.L. 113-291) expands eligibility for the Purple Heart by redefining what should be considered an attack by a foreign terrorist organization, and awards Purple Heart medals to servicemembers wounded or killed during the 2009 shootings at Ft. Hood, Texas, and Little Rock, Arkansas.

Figure A-1. The Purple Heart Medal

Obverse (Front)

Source: http://www.afpc.af.mil/shared/media/ggallery/hires/AFG-070807-013.jpg.

Reverse (Back)

Source: The Institute of Heraldry. Personal Decorations: Purple Heart at http://www.tioh.hqda.pentagon.mil/Catalog/ViewImage.aspx?id=10276.

Staffer Instructions for Medal Requests

Members of Congress are able to directly request that a Service Secretary consider awarding military decorations to individuals or groups. Upon receiving a request from a Member's office, the Service Secretary concerned will review the proposal for the award or presentation of a decoration (or the upgrading of a decoration).

Based on that review, the Secretary shall determine the merits of approving the award or presentation of the decoration and other necessary determinations. The Secretary shall submit a notice to the requesting Member, the Senate Armed Services Committee, and the House Armed Services Committee with one of the following results:

(1) The award or presentation of the decoration does not warrant approval on the merits. A statement explaining the Secretary's reason will be included.

(2) The award or presentation of the decoration warrants approval and a waiver by law of time restrictions prescribed by law is recommended.

(3) The award or presentation of the decoration warrants approval on the merits and has been approved as an exception to policy.

(4) The award or presentation of the decoration warrants approval on the merits, but a waiver of the time restrictions prescribed in law is not recommended. A statement explaining the Secretary's reason will be included.

Source: Compiled from the National Defense Authorization Act for Fiscal Year 1996 (P.L. 104-106, §526), February 10, 1996.

Author Contact Information

[author name scrubbed], Analyst in Defense Budget and Military Manpower ([email address scrubbed], [phone number scrubbed])

Acknowledgments

This report was originally authored by Fenwick Gilroy, former research associate, and [author name scrubbed], specialist in Military Manpower Policy. All questions should be directed to the current author.

Footnotes

1.

According to estimates by the Military Order of the Purple Heart as of April 1, 2015, there are approximately 35,431 Purple Heart recipients from the war in Iraq and 21,910 from Afghanistan including Operation New Dawn, and other casualties. See Military Order of the Purple Heart, "Purple Heart Recipients," on PDF p.7 at http://www.purpleheart.org/DownLoads/Bank/MOPHInformationalBrochures/MOPHToday.pdf.

2.

Gene Beresin, "Why Are We Denying Purple Hearts to Veterans with PTSD?" Huffington Post (updated) May 3, 2015, at http://www.huffingtonpost.com/gene-beresin/why-are-we-denying-purple_b_6786318.html.

3.

U.S. Constitution, Art. I, §8, clause 14.

4.

John C Fitzpatrick, The Writings of George Washington from the Original Manuscript Sources 1745-1799, vol. 24 (United States Government Printing Office), p. 488.

5.

Ibid.

6.

Military Order of the Purple Heart, "Updated History of the Purple Heart," on p.9 at http://www.purpleheart.org/DownLoads/Bank/MOPHInformationalBrochures/HistoryOfThePurpleHeart.pdf.

7.

General Douglas MacArthur, War Department, General Orders No. 3, February 22, 1932.

8.

See Appendix A "The Purple Heart Medal."

9.

Army Regulation (AR) 600-8-22, Military Awards, revised 25 June 2015, at http://www.apd.army.mil/pdffiles/r600_8_22.pdf.

10.

Executive Order 9277, "Award of the Purple Heart to Persons Serving with the Navy, Marine Corps, or Coast Guard of the United States," 7 Federal Register 10125, December 5, 1942.

11.

Executive Order 10409, "Award of the Purple Heart to Persons Serving with the Navy, Marine Corps, or Coast Guard of the United States," 17 Federal Register 10397, November 14, 1952.

12.

Executive Order 11016, "Authorizing Award of the Purple Heart," 27 Federal Register 4139, April 25, 1962.

13.

William B Theyer, "The Oldest Military Decoration, the Purple Heart, is Proof Positive that One Has 'Seen the Elephant,'" Supplement, October 1991, p. 58.

14.

Executive Order 12464, "Award of the Purple Heart," 49 Federal Register 7099, February 27, 1984.

15.

Madeline Sapienza, Peacetime Awards of the Purple Heart in the Post-Vietnam Period, U.S. Army Center for Military History, Washington, DC, July 1987.

16.

110 Stat. 186, P.L. 104-106, February 10, 1996.

17.

111 Stat. 1756, P.L. 105-85, November 18, 1997. Some sources report that this change was prompted by complaints from groups that were upset when President Clinton posthumously awarded a Purple Heart to Commerce Secretary Ron Brown, who was killed in a plane crash while on a government mission to Croatia in 1996. Rick Maze, "New Medal Approved for Civilians," Army Times, 2001, http://www.armytimes.com/legacy/new/0-ARMYPAPER-504279.php.

18.

Department of Defense, Manual of Military Decorations and Awards: Vol. 3, Manual 1348.33, November 23, 2010, Incorporating Change 2, March 13, 2015, pp. 22-25, http://www.dtic.mil/whs/directives/corres/pdf/134833vol3.pdf.

19.

Prisoners of War after December 7, 1941: a servicemember who has been killed (executed) or who has died (due to living conditions or treatment by the enemy) and maintained honorable character while a prisoner of war, unless evidence shows that the servicemember's death was not a result of enemy action (such as suicide).

20.

Jim Garamone, "DOD Issues Purple Heart Standards for Brain Injury," Defense News, April 28, 2011; Department of Defense, Manual of Military Decorations and Awards: Vol. 3, Manual 1348.33, November 23, 2010, Incorporating Change 2, March 13, 2015, pp. 23-26, http://www.dtic.mil/whs/directives/corres/pdf/134833vol3.pdf.

21.

Ibid.

22.

See an example at "Medal #6 Purple Heart with Oak Leaf Clusters," Audie L. Murphy Memorial Website, at http://www.audiemurphy.com/decorations006.htm. Note: Murphy was the most decorated U.S. soldier during WWII.

23.

U.S. Constitution, Art. I, §8, clause 14.

24.

See Appendix A.

25.

Steve Barnes and James Dao, "Gunman Kills Soldier outside Recruiting Station," The New York Times, June 2, 2009, at http://www.nytimes.com/2009/06/02/us/02recruit.html?_r=1.

26.

"Officials: Fort Hood Shooting Suspect Alive; 12 Dead," CNN.com, November 5, 2009, at http://articles.cnn.com/2009-11-05/us/texas.fort.hood.shootings_1_gen-robert-cone-nidal-malik-hasan-fort-hood?_s=PM:US.

27.

Department of Defense, "DOD Releases Final Fort Hood Review," Press Release No: 749-10, August 20, 2010, at http://archive.defense.gov/Releases/Release.aspx?ReleaseID=13816.

28.

Andrew Tilghman, "No Purple Heart for Victim of Islamic Radical," Army Times, December 15, 2011. http://www.armytimes.com/news/2011/12/military-no-purple-heart-for-victim-of-islamic-radical-121611w/.

29.

Sig Christenson, "Some Labeling Hasan Terrorist," San Antonio Express-News, August 13, 2012. http://www.mysanantonio.com/news/local_news/article/Some-labeling-Hasan-terrorist-3783225.php.

30.

Secretary of Defense Memorandum, "Final Recommendations of the Ft. Hood Follow-on Review," August 18, 2010, at http://archive.defense.gov/news/d20100820FortHoodFollowon.pdf; and Protecting the Force: Lessons From Fort Hood, DOD Independent Review Related to Fort Hood, January 2010, see Finding 2.6 on pp. 15-16 (PDF pp.19-20), at http://www.defense.gov/Portals/1/Documents/pubs/DOD-ProtectingTheForce-Web_Security_HR_13Jan10.pdf

31.

Heather Graham-Ashley, "Fort Hood Shooting Victims, Families Receive Medals," DOD News, April 11, 2015, at http://www.defense.gov/News-Article-View/Article/60r43/fort-hood-shooting-victims-families-receive-medals.

32.

Army Public Affairs, "McHugh orders benefits be provided to Purple Heart recipients," April 16, 2015, at http://www.army.mil/article/146546/McHugh_orders_benefits_be_provided_to_Purple_Heart_recipients/; and Michelle Tan, "Army Extends Benefits to Hood Shooting Victims," Army Times, April 16, 2015, at http://www.armytimes.com/story/military/pentagon/2015/04/16/fort-hood-purple-heart-benefits/25874715/.

33.

Claudia Lauer, "Army Recruiters Shot in Little Rock to Receive Purple Heart," Military Times, April 16, 2015, at http://www.militarytimes.com/story/military/2015/04/16/army-recruiters-shot-in-little-rock-to-receive-purple-heart/25909841/.

34.

CRS Report R44120, FY2016 National Defense Authorization Act: Selected Military Personnel Issues, coordinated by [author name scrubbed], p. 23.

35.

Killed were the following Marines: Sgt. Carson Holmquist, Gunnery Sgt. Thomas J. Sullivan, Lance Cpl. Squire K. Wells, and Staff Sgt. David A. Wyatt, and Navy Petty Officer 2nd Class Randall Smith.

36.

Travis J. Tritten, "Purple Hearts for Chattanooga Shooting Victims Depend on FBI's findings," Stars and Stripes, July 24, 2015, at http://www.stripes.com/purple-hearts-for-chattanooga-shooting-victims-depend-on-fbi-s-findings-1.359603.

37.

"Invisible wounds" a term used to describe psychological and cognitive injuries. See Terri Tanielian and Lisa H. Jaycox, editors, Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery, Rand Corporation, 2008, at http://www.rand.org/content/dam/rand/pubs/monographs/2008/RAND_MG720.sum.pdf.

38.

The National Institutes of Health (NIH) classifies PTSD as an anxiety disorder that often occurs after experiencing a traumatic event, such as disaster, assault, abuse, prison, or war. The cause of PTSD is unknown, although psychological, genetic, social, and physical factors are involved. There are also no tests to diagnose PTSD; doctors make the diagnosis based on a medical professional's judgment of the symptoms. It is unclear why a traumatic event causes PTSD in some people and not in others. PubMed Health, updated February 13, 2012, at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001923/.

39.

Jim Garamone, "DOD Issues Purple Heart Standards for Brain Injury," Defense.gov, April 28, 2011. http://www.defense.gov/news/newsarticle.aspx?id=63723, and "Army Clarifies Award of Purple Heart for Concussion," U.S. Army, May 2, 2011, at http://www.army.mil/article/55850/.

40.

CRS Report R40941, Health Care for Veterans: Traumatic Brain Injury, by [author name scrubbed].

41.

National Alliance on Mental Illness, Parity for Patriots: The Mental Health Needs of Military Personnel, Veterans, and their Families, Arlington, VA, June 2012, p. 6, at http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Public_Policy/Policy_Reports/ParityforPatriots.pdf.

42.

Department of the Army, Army Regulation 600-8-22, Military Awards, June 25, 2015, See h. Examples of injuries or wounds which clearly do not justify award of the Purple Heart (10) Post traumatic stress disorders on p. 23, at http://www.apd.army.mil/pdffiles/r600_8_22.pdf.

43.

Ibid.

44.

Manpower Management Division, Manpower and Reserve Affairs, Headquarters Marine Corps, Purple Heart Medal-Revised Criteria for Mild Traumatic Brain Injury and Updated Coordinating Instructions, MARADMIN 245/11, April 15, 2011, at http://www.marines.mil/News/Messages/MessagesDisplay/tabid/13286/Article/111311/purple-heart-medal-revised-criteria-for-mild-traumatic-brain-injury-and-updated.aspx.

45.

Jacqueline Kilmas, "Fort Hood's Mentally Wounded Veterans Don't Qualify for Purple Hearts 2009 Shooting," Washington Times, April 9, 2015, at http://www.washingtontimes.com/news/2015/apr/9/ft-hoods-mentally-wounded-veterans-dont-qualify-fo/?page=all.

46.

Ibid.

47.

Barrie Barber, "Purple Hearts for PTSD Debated," Dayton Daily News, June 9, 2012. http://www.daytondailynews.com/news/news/local/purple-hearts-for-ptsd-debated-3/nPgwh/.