Purple Heart Medal
and Medal Display Recognition

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      • Example Display Recognition
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      • Applicable Military Branches
      • Display Types
      • Issue Requirements
      • Issue Regulations
      • Who May Apply
      • The Purple Heart
      • Executive Order 11016
      • Friendly Fire
      • Prisoner of War
      • Administration Processing and Delivery
      • How To Apply For This Display Recognition and/or Medal
      • Mailing Address
      • Questions?
      • Wound Chevron Display Recognition (WWI)
      • Wound Medal Display Recognition (Vietnam)
      • Other Display Recognitions
      • Purple Heart Registry Application
      • Common Myths about the Purple Heart medal
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      • Military Medals Discussion Forum
      • Example Display Recognition:
        Actual Size: 8 1/2 x 11



        Military Branches

        All Military Service branches are applicable:
        Air Force, Army, Coast Guard, Marine Corps, Navy

        Who May Apply

        • Veteran recipients
        • Active Duty recipients
        • Family Members of recipients
        • Estate Inheritors

        Display Types

        You have four display types to choose from:
        Black & White (No Color)
        Heavy Bond Enclosure

        Heavy Bond Enclosure
        Colors: Regal, Black, Navy
        Trimmed in Appearance Gold

        Ready for Mantle or Shelf Display

        Issue Requirements
        You must submit the following:

      • An unaltered photocopy of your DD-214 or DD-214 and DD-215 (post WW2), OR unaltered photocopy of WD AGO 53-55 (WW2). (See below for KIA information)
      • Contact The War Library if you do not have a DD-214: 1-310-532-0634.
      • A DD-214, DD-215 or WD AGO 53-55 is not required when requesting a display Recognition for hostile or friendly fire KIA's
      • NOTICE

        This Display Recognition is available ONLY to authorized recipients who possess orders, or authorization form, or release documentation that confirms award eligibility. (See "Issue Requirements"). To obtain either a Display Medal or a Display Recognition for your authorized award you will be required to provide military-issued documentation authorizing your award. There are no exceptions.

        WARNING!
        You must NOT submit a military issued document or photocopy that:

        • has been altered in any way by you after
          the original's official issue
        • contains information or corrections or
          additions that you entered
        • lists awards or training you knowingly did not receive
        • contains highlighting, colorizing or other markings you entered

        Be advised that on request any knowingly fraudulent document sent by you will be released to the Federal Bureau of Investigation (FBI) that may result in prosecution and/or fine/imprisonment.

        Email Questions, or Phone: 310-532-0634

        Personnel Branch
        Processing and Delivery

        Style Admin Shipping Total
        Full Color .PDF (Printable) $7.50 Emailed $7.50
        Published Document only (Full Color) $14.00 $7.15 $21.15
        Published Document in Heavy Bond Enclosure (Full Color) $19.00 $7.15 $26.15
        Full Color Printable Certificates
        on CD-Rom (minimum 20 Certificates)
        $7.50 $7.50 By Count

      • Total/Shipping fees, above, apply to 50 U.S. states
      • Contact The War Library for international shipping cost
      • How to Apply

        You may apply for your Display Recognition using a...

      • Check Debit card (* Shipped within 1 week)
      • Charge card (* Shipped within 1 week)
      • Personal, Business, Bank or Cashiers Check ( Shipped in 6 weeks)
      • Money Order (* Shipped within 1 week)
      • (* Upon reception of required documentation)

        Complete and MAIL this APPLICATION FORM.
        Don't forget to include an unaltered COPY of your DD-214, DD-215 or other pre-arranged document(s).

        DISPLAY RECOGNITION and/or MEDAL APPLICATION FORM

        Mailing Address

        Records Chief (REC-AMW)
        The American War Library
        16907 Brighton Avenue
        Gardena CA 90247-5420

        Questions?

        Click here for answers to common questions

        Email: Recognition Inquiry

        Telephone: 1-310-532-0634

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        Issue Regulations
        The Purple Heart


        Click for larger image

        A. Established by General George Washington -- known as the "Badge of Military Merit"-- on August 7, 1782. Revived as the Purple Heart in 1932 by General Douglas MacArthur (War Department General Orders No. 3, as amended (reference (ttt)) and Navy authority is Executive Order 9277 (reference )). b. Awarded to any member of the Armed Forces of the United States or any civilian national of the United States who, while serving under competent authority in any capacity with one of the U.S. Armed Forces, after April 5, 1917, has been wounded, killed, or who has died or may hereafter die of wounds received under any of the following circumstances:

        (1) In action against an enemy of the United States.
        (2) In action with an opposing armed force of a foreign country in which the Armed Forces of the United States are or have been engaged.
        (3) While serving with friendly foreign forces engaged in an 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 of 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.
        (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) A Service member who is killed or wounded in action as the result of action by friendly weapon fue while directly engaged in armed conflict, other than as a result of an act of an enemy of the U. S., unless (in the case of a wound) the wound is the result of willful misconduct of the member under Section 1129, title 10, U.S.C. (reference (uuu)).
        (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 a prisoner of war (or while being taken captive under Section 521, DoD Authorization Act for 1996 (reference (vvv)).

        Subsequent Awards.

        • (Army/AF) Bronze Oak Leaf Cluster is worn for each additional award.
        • (Navy/USMC/CG) Gold Star is worn for each additional award.
        • (Army/AF) Silver OLC is worn in lieu of 5 Bronze OLCs.
        • (Navy/USMC/CG) Silver Star is worn in lieu of 5 Gold Stars.

        Executive Order 11016
        Authorizing award of the Purple Heart

        Source: The provisions of Executive Order 11016 of Apr. 25, 1962, appear at 27 FR 4139, 3 CFR, 1959-1963 Comp., p. 596, unless otherwise noted.

        WHEREAS General George Washington, at Newburg-on-the-Hudson, on August 7, 1782, during the War of the Revolution, issued an Order establishing the Honorary Badge of Distinction, otherwise known as the Badge of Military Merit or Decoration of the Purple Heart; and

        WHEREAS the award of that decoration ceased with the closing of the War of the Revolution and was revived on February 22, 1932, out of respect to the memory and military achievements of General George Washington, by War Department General Orders No. 3:

        NOW, THEREFORE, by virtue of the authority vested in me as President of the United States and as Commander in Chief of the armed forces of the United States, it is ordered as follows:

        1. The Secretary of a military department, or the Secretary of Transportation with regard to the Coast Guard when not operating as a service in the Navy, shall, in the name of the President of the United States, award the Purple Heart, with suitable ribbons and appurtenances, to any member of an armed force under the jurisdiction of that department and any civilian national of the United States who, while serving under competent authority in any capacity with an armed force of that department, has been, or may hereafter be, wounded--

        (a) in any action against an enemy of the United States;
        (b) in any action with an opposing armed force of a foreign country in which the armed forces of the United States are or have been engaged;
        (c) while serving with friendly foreign forces engaged in an armed conflict against an opposing armed force in which the United States is not a belligerent party;
        (d) as the result of an act of any such enemy or opposing armed force;
        (e) as the result of an act of any hostile foreign force;
        (f) 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 the purposes of this Order by the Secretary of the department concerned, or jointly by the Secretaries of the departments concerned if persons from more than one department are wounded in the attack; or
        (g) 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.

        [Para. 1 amended by Executive Order 11382 of Nov. 28, 1967, 32 FR 16247, 3 CFR, 1966-1970 Comp., p. 691; Executive Order 12464 of Feb. 23, 1984, 49 FR 7099, 3 CFR, 1984 Comp., p. 163]

        2. The Secretary of a military department, or the Secretary of Transportation, shall, in the name of the President of the United States, award the Purple Heart, with suitable ribbons and appurtenances, posthumously, to any person covered by, and under the circumstances described in,--

        (a) paragraphs 1(a)-(e) who, after April 5, 1917; or
        (b) paragraphs 1(f)-(g) who, after March 28, 1973, has been, or may hereafter be, killed, or who has died or may hereafter die after being wounded.

        [Para. 2 amended by Executive Order 12464 of Feb. 23, 1964, 49 FR 7099, 3 CFR, 1984 Comp., p. 163]

        3. A wound for which the award is made must have required treatment by a medical officer.

        4. The Purple Heart shall be forwarded to the next of kin of any person entitled to the posthumous award, without respect to whether a previous award has been made to such person, except that if the award results from service before December 7, 1941, the Purple Heart shall be forwarded to such next of kin upon his application therefor to the Secretary of the department concerned.

        5. Except as authorized in paragraph 4, not more than one Purple Heart shall be awarded to any person, but for each subsequent award a Gold Star, or other suitable device, shall be awarded to be worn with the Purple Heart as prescribed by appropriate regulations to be issued by the Secretary of the department concerned.

        6. When authorized by the Secretary of the department concerned, the award of the Purple Heart may be made by subordinate military commanders, or such other appropriate officers as the Secretary concerned may designate.

        7. The Secretary of the department concerned may prescribe such regulations as he considers appropriate to carry out this order. The regulations of the Secretaries of the departments with respect to the award of the Purple Heart shall, so far as practicable, be uniform, and those of the military departments shall be subject to the approval of the Secretary of Defense.

        8. This order supersedes Executive Order No. 10409 of November 12, 1952, entitled "Award of the Purple Heart to Persons Serving with the Navy, Marine Corps, or Coast Guard of the United States". However, existing regulations prescribed pursuant to that order, together with regulations prescribed under the authority of General Orders No. 3, War Department, February 22, 1932, shall, so far as they are not inconsistent with this order, remain in effect until modified or revoked by regulations prescribed by the Secretary of the department concerned under this order.

        Friendly Fire

        10 USC Sec. 1129 01/05/99
        TITLE 10 - ARMED FORCES
        Subtitle A - General Military Law
        PART II - PERSONNEL
        CHAPTER 57 - DECORATIONS AND AWARDS

        Sec. 1129. Purple Heart: members killed or wounded in action by friendly fire

        -STATUTE-

        (a) For purposes of the award of the Purple Heart, the Secretary concerned shall treat a member of the armed forces described in subsection (b) in the same manner as a member who is killed or wounded in action as the result of an act of an enemy of the United States.

        (b) A member described in this subsection is a member who is killed or wounded in action by weapon fire while directly engaged in armed conflict, other than as the 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.

        (c) This section applies to members of the armed forces who are killed or wounded on or after December 7, 1941. In the case of a member killed or wounded as described in subsection (b) on or after December 7, 1941, and before November 30, 1993, the Secretary concerned shall award the Purple Heart under subsection (a) in each case which is known to the Secretary before such date or for which an application is made to the Secretary in such manner as the Secretary requires.

        (Added Pub. L. 103-160, div. A, title XI, Sec. 1141(a), Nov. 30, 1993, 107 Stat. 1756; amended Pub. L. 105-85, div. A, title X, Sec. 1073(a)(18), Nov. 18, 1997, 111 Stat. 1901.)

        AMENDMENTS

        1997 - Subsec. (c). Pub. L. 105-85 substituted "November 30, 1993," for "the date of the enactment of this section," and "before such date or" for "before the date of the enactment of this section or".

        Award Of Purple Heart To Persons Wounded While Held As Prisoners Of War Before April 25, 1962

        Pub. L. 104-106, div. A, title V, Sec. 521, Feb. 10, 1996, 110 Stat. 309, provided that:

        "(a) Award of Purple Heart. - For purposes of the award of the Purple Heart, the Secretary concerned (as defined in section 101 of title 10, United States Code) shall treat a former prisoner of war who was 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).

        "(b) Standards for Award. - An award of the Purple Heart under subsection (a) shall be made in accordance with the standards in effect on the date of the enactment of this Act (Feb. 10, 1996) for the award of the Purple Heart to persons wounded on or after April 25, 1962.

        "(c) Eligible Former Prisoners of War. - A person shall be considered to be a former prisoner of war for purposes of this section if the person is eligible for the prisoner-of-war medal under section 1128 of title 10, United States Code."


        Prisoner of War Update Issue Regulations

        IMMEDIATE RELEASE No. 845-08
        October 06, 2008

        DoD Revises Purple Heart Eligibility Criteria to Allow Award to POWs Who Die in Captivity

        The Department of Defense announced today it has expanded the Purple Heart eligibility criteria allowing prisoners-of-war who died in captivity to receive the award.

        The revised department policy presumes, for service members who die in captivity as a qualifying prisoner-of-war, that their death was the "result of enemy action," or the result of wounds incurred "in action with the enemy" during capture, or as a result of wounds incurred as a "result of enemy action" during capture, unless compelling evidence is presented to the contrary.

        The revised policy allows retroactive award of the Purple Heart to qualifying prisoners-of-war since Dec. 7, 1941. Posthumous award will be made to the deceased service member's representative, as designated by the secretary of the military department concerned, upon application to that military department.

        Each military department will publish application procedures and ensure they are accessible by the general public. Family members with questions may contact the services: Army: Military Awards Branch, (703) 325-8700; Navy: Navy Personnel Command, Retired Records Section, (314) 592-1150; Air Force: Air Force Personnel Center, (800) 616-3775; Marine Corps: Military Awards Branch, (703) 784-9340. For further information, media representatives should contact Eileen Lainez, (703) 695-3895, eileen.lainez@osd.mil.

        U.S. Department of Defense Office of the Assistant Secretary of Defense (Public Affairs)

        US Navy Update Issue Regulations

        INFO SECNAV WASHINGTON DC
        CNO WASHINGTON DC
        ALNAV 079/11
        SUBJ/DEPARTMENT OF THE NAVY STANDARDS FOR AWARD OF THE PURPLE HEART (PH)

        NARR/REFERENCE A IS EXECUTIVE ORDER 11016 AUTHORIZING THE PH. REFERENCE B IS DEPARTMENT OF DEFENSE MANUAL (DODM) 1348.33 VOLUME 3, MILITARY DECORATIONS AND AWARDS. REFERENCE C IS SECNAVINST 1650.1H NAVY AND MARINE CORPS AWARDS MANUAL. REFERENCE D IS THE MEMORANDUM FROM UNDER SECRETARY OF DEFENSE PERSONNEL AND READINESS TO MILITARY DEPARTMENT SECRETARIES REGARDING PH FOR MILD TRAUMATIC BRAIN INJURY (MTBI). REFERENCE E IS DIRECTIVE-TYPE MEMORANDUM 09-033, POLICY GUIDANCE FOR MANAGEMENT OF CONCUSSION/MILD TRAUMATIC BRAIN INJURY IN THE DEPLOYED SETTING UPDATED W CH2 ON 22 FEB 2011. REFERENCE F IS MARADMIN 245- 11. REFERENCE G IS MCO 3040.4 MARINE CORPS CASUALTY ASSISTANCE PROGRAM. REFERENCE H IS MILPERSMAN 1770 CASUALTIES AND SURVIVOR BENEFITS.

        POC/J. NIERLE/CIV/NDBDM/TEL: 202-685-6397/-

        RMKS/1. THIS ALL NAVY (ALNAV) MESSAGE CLARIFIES AND UPDATES THE DEPARTMENT OF THE NAVY (DON) POLICY FOR AWARD OF THE PH. THE PURPOSE OF THIS ALNAV IS TO ENHANCE CONSISTENCY ACROSS THE DON BY PROVIDING AMPLIFYING GUIDANCE TO ASSIST PH AWARDING AUTHORITIES IN APPLYING THE PH CRITERIA TO INDIVIDUAL CASES. DETAILED GUIDANCE IS INCLUDED CONCERNING AWARD OF THE PH FOR MTBI. THE BASIC ELIGIBILITY AND CRITERIA CONTAINED IN REFERENCES A THROUGH C REMAIN UNCHANGED, AND THIS MESSAGE DOES NOT CANCEL PREVIOUS GUIDANCE PUBLISHED WITHIN DON CONCERNING AWARD OF THE PH FOR WOUNDS OTHER THAN MTBI. THE STANDARDS SET FORTH IN THIS ALNAV ARE EFFECTIVE IMMEDIATELY AND MAY BE RETROACTIVELY APPLIED FOR CERTAIN INSTANCES OF MTBI SUFFERED ON OR AFTER SEPTEMBER 11, 2001. RETROACTIVE AWARDS ARE ADDRESSED FURTHER IN PARAGRAPH 11 OF THIS ALNAV.

        2. PER REFERENCE C, THE PH MAY ONLY BE AWARDED WITHIN THE DON IF BOTH OF THE FOLLOWING CRITERIA ARE MET:

        A. THE WOUND WAS THE DIRECT OR INDIRECT RESULT OF ENEMY ACTION, AND

        B. THE WOUND REQUIRED TREATMENT BY A MEDICAL OFFICER AT THE TIME OF INJURY.

        3. CLARIFICATION OF CRITERION 2A: WOUND WAS THE DIRECT OR INDIRECT RESULT OF ENEMY ACTION.

        A. WOUND IS DEFINED BY REFERENCE B AS AN INJURY TO ANY PART OF THE BODY FROM AN OUTSIDE FORCE OR AGENT.

        B. WOUNDS/INJURIES ARE THE DIRECT RESULT OF ENEMY ACTION WHEN THE PHYSICAL EFFECTS OF AN ENEMY WEAPON ON THE SERVICE MEMBER ARE THE IMMEDIATE CAUSE OF THE WOUND/INJURY (E.G., BEING STRUCK BY PROJECTILES, FRAGMENTATION, OR BLAST FROM AN ENEMY WEAPON OR IMPROVISED EXPLOSIVE DEVICE).

        C. WOUNDS/INJURIES ARE THE INDIRECT RESULT OF ENEMY ACTION WHEN THE SERVICE MEMBER IS INJURED BY A SUBSEQUENT ACTION THAT IS SOLELY THE RESULT OF THE EFFECTS OF THE ENEMY WEAPON (E.G., AIRCRAFT IS DAMAGED BY ENEMY MISSILE, FORCING THE CREW TO EJECT AND THEY SUSTAIN INJURIES AS A RESULT OF THE EJECTION).

        D. ACCIDENTAL INJURIES. INJURIES SUFFERED DUE TO AN ACCIDENT THAT IS NEITHER DIRECTLY NOR INDIRECTLY CAUSED BY THE EFFECTS OF ENEMY WEAPONS DO NOT MEET THE ELIGIBILITY REQUIREMENTS FOR THE PH, EVEN IF THE ACCIDENT OCCURS IN A COMBAT ZONE OR DURING AN ENGAGEMENT WITH THE ENEMY. EXAMPLES OF SUCH ACCIDENTAL WOUNDS/INJURIES THAT WOULD NOT QUALIFY FOR THE PH ARE:

        (1) INJURIES SUFFERED DUE TO A MOTOR VEHICLE MISHAP THAT IS NOT CAUSED BY IMPACT OF AN ENEMY WEAPON TO THE VEHICLE OR DRIVER, EVEN IF THE MISHAP IS DUE TO EVASIVE MANEUVERS.

        (2) INJURIES SUSTAINED WHILE SEEKING SHELTER, ESCAPING, OR EVADING.

        E. WOUNDS CAUSED BY UNKNOWN/UNIDENTIFIED INDIVIDUALS. WITHIN A COMBAT ZONE, THE WOUNDED SERVICE MEMBER'S COMMANDING OFFICER SHALL MAKE THE DETERMINATION AS TO WHETHER WEAPONS FIRED BY UNKNOWN INDIVIDUALS WERE LIKELY FIRED BY ENEMY COMBATANTS. IF SO, WOUNDS RECEIVED FROM THOSE WEAPONS MAY QUALIFY FOR THE PH. OUTSIDE OF A COMBAT ZONE, WOUNDS/INJURIES CAUSED BY THE ACTIONS OF UNKNOWN INDIVIDUALS, OR AS A RESULT OF CRIMINAL ACTIONS, SHALL NOT BE ASSUMED TO BE CAUSED BY ENEMY ACTION, AND SHALL NOT QUALIFY FOR AWARD OF THE PH UNLESS THE WOUND IS DETERMINED TO BE THE RESULT OF AN INTERNATIONAL TERRORIST ATTACK.

        4. CLARIFICATION OF CRITERION 2B: WOUND REQUIRED TREATMENT BY A MEDICAL OFFICER AT THE TIME OF INJURY.

        A. PER REFERENCE B A MEDICAL OFFICER IS A PHYSICIAN WITH OFFICER RANK.

        B. MEDICAL OFFICERS ARE DISTINCT FROM CIVILIAN PHYSICIANS AND PHYSICIAN EXTENDERS, A TERM THAT APPLIES TO OTHER PERSONNEL WHO MAY BE INVOLVED IN THE TREATMENT OF WOUNDS, SUCH AS PHYSICIANS ASSISTANTS (PA), NURSE PRACTITIONERS (NP), INDEPENDENT DUTY CORPSMEN (IDC), SPECIAL FORCES MEDICS, AND SPECIAL AMPHIBIOUS RECONNAISSANCE CORPSMEN (SARC). BASIC CORPSMEN AND BASIC MEDICS ARE NOT CLASSIFIED AS PHYSICIAN EXTENDERS.

        C. SOMETIMES A WOUND THAT WOULD NORMALLY REQUIRE TREATMENT BY A MEDICAL OFFICER MUST BE TREATED BY A PHYSICIAN EXTENDER OR CORPSMEN/MEDIC AT A FORWARD DEPLOYED LOCATION BECAUSE EVACUATION TO A FACILITY WITH A MEDICAL OFFICER IS NOT TACTICALLY FEASIBLE. IN SUCH SITUATIONS, A PH MAY BE APPROVED IF THE COMMANDER WITH PH APPROVAL AUTHORITY DETERMINES THAT THE WOUND/INJURY WOULD HAVE NORMALLY REQUIRED TREATMENT BY A MEDICAL OFFICER HAD ONE BEEN AVAILABLE. THIS DETERMINATION CAN BE MADE BASED UPON EITHER THE INFORMATION PROVIDED IN PERSONNEL CASUALTY REPORTS OR REVIEW OF THE WOUNDED SERVICE MEMBER'S MEDICAL RECORD BY THE SUPERVISING MEDICAL OFFICER, OR THE ADVICE OF THE COMMANDER'S STAFF SURGEON AFTER REVIEW OF THE MEDICAL DOCUMENTATION AVAILABLE. IN ANY CASE, PER REFERENCE B THERE MUST BE A WRITTEN STATEMENT FROM A MEDICAL OFFICER SUBSTANTIATING THE DETERMINATION.

        D. EVALUATION BY A MEDICAL OFFICER SOLELY TO DETERMINE THE EXTENT OF AN INJURY DOES NOT MEET THE PH THRESHOLD OF REQUIRING TREATMENT BY A MEDICAL OFFICER IF THE INJURY IS DETERMINED TO BE AT A LEVEL THAT COULD HAVE BEEN ADEQUATELY TREATED BY A PHYSICIAN EXTENDER OR A CORPSMAN/MEDIC. LIKEWISE, A DECISION BY A MEDICAL OFFICER TO TREAT A MINOR WOUND THAT A CORPSMAN COULD HAVE ADEQUATELY TREATED DOES NOT MEAN THE WOUND REQUIRED TREATMENT BY A MEDICAL OFFICER. AWARD OF THE PH WOULD NOT BE AUTHORIZED IN EITHER OF THESE TWO EXAMPLE SITUATIONS.

        5. EXAMPLES OF WOUNDS THAT NORMALLY QUALIFY FOR AWARD OF THE PH. IN CASES IN WHICH THE REQUIREMENTS IN PARAGRAPHS 2A AND 2B HAVE BEEN MET, THE FOLLOWING TYPES OF WOUNDS/INJURIES ARE CONSISTENT WITH DEPARTMENT OF THE NAVY STANDARDS FOR AWARD OF THE PH:

        A. FRAGMENTATION WOUNDS.

        B. LACERATIONS.

        C. FRACTURES.

        D. GUNSHOT WOUNDS.

        E. PERFORATED EARDRUM.

        F. MODERATE OR SEVERE/PENETRATING TRAUMATIC BRAIN INJURIES (TBI) (SEE ADDITIONAL INFORMATION IN PARAGRAPH 9 BELOW).

        G. MTBI/CONCUSSIONS SEVERE ENOUGH TO CAUSE EITHER LOSS OF CONSCIOUSNESS (LOC) OR RESTRICTION FROM FULL DUTY DUE TO PERSISTENT SIGNS, SYMPTOMS, OR CLINICAL FINDINGS OF IMPAIRED BRAIN FUNCTION FOR A PERIOD GREATER THAN 48 HOURS FROM THE TIME OF THE CONCUSSIVE INCIDENT.

        (1) THE 48 HOUR PERIOD DOES NOT INCLUDE ASSIGNMENT TO ADMINISTRATIVE LIGHT DUTY SOLELY FOR A MANDATORY PERIOD OF OBSERVATION/SCREENING AS REQUIRED BY MEDICAL PROTOCOLS (SUCH AS REFERENCE E) FOR EVALUATION OF INDIVIDUALS WHO MAY HAVE HAD SOME BLAST EXPOSURE, REGARDLESS OF THE PRESENCE OF ANY SIGNS, SYMPTOMS, AND FINDINGS OF IMPAIRED BRAIN FUNCTION.

        (2) THE MEDICAL OFFICER DISPOSITION OF MTBI/CONCUSSION WITH EITHER LOC OR MORE THAN 48 HOUR RESTRICTION FROM RETURN TO FULL DUTY MUST BE MADE WITHIN SEVEN (7) DAYS OF THE CONCUSSIVE EVENT.

        (3) SEE ADDITIONAL INFORMATION ON TBI IN PARAGRAPH 9 BELOW.

        H. SMOKE INHALATION SEVERE ENOUGH TO CAUSE 1ST TO 3RD DEGREE BURNS TO THE RESPIRATORY TRACT.

        I. CORNEAL ABRASIONS.

        J. EFFECTS OF CHEMICAL, BIOLOGICAL, OR NUCLEAR WEAPONS (TO INCLUDE CHLORINE GAS USED BY THE ENEMY IN CONJUNCTION WITH AN IED).

        K. 2ND AND 3RD DEGREE BURNS.

        6. FRIENDLY FIRE INCIDENTS. NAVY AND MARINE CORPS PERSONNEL RECEIVING THE ABOVE WOUNDS/INJURIES AS A RESULT OF FRIENDLY FIRE ARE ONLY ELIGIBLE FOR THE PH IF THEY WERE ACTIVELY ENGAGING THE ENEMY AT THE TIME OF THE INJURY.

        7. MULTIPLE WOUNDS. IF MULTIPLE WOUNDS ARE RECEIVED AT THE SAME INSTANT OR FROM THE SAME MISSILE, FORCE, EXPLOSION, OR AGENT, ONLY ONE AWARD OF THE PH WILL BE MADE.

        8. NON-QUALIFYING WOUNDS. THE FOLLOWING ARE EXAMPLES OF WOUNDS/INJURIES THAT ARE NOT CONSISTENT WITH DEPARTMENT OF THE NAVY STANDARDS FOR AWARD OF THE PH:

        A. COLD AND HEAT RELATED INJURIES (E.G., FROSTBITE AND HEATSTROKE).

        B. HEARING LOSS AND TINNITUS (I.E., RINGING IN THE EARS).

        C. MTBI/CONCUSSIONS THAT DO NOT EITHER RESULT IN LOC OR RESTRICTION FROM FULL DUTY FOR A PERIOD GREATER THAN 48 HOURS DUE TO PERSISTENT SIGNS, SYMPTOMS, OR CLINICAL FINDINGS OF IMPAIRED BRAIN FUNCTION.

        D. POST TRAUMATIC STRESS DISORDER (PTSD) OR COMBAT STRESS INJURIES.

        E. DISEASE (UNLESS THE RESULT OF AN ENEMY OR TERRORIST NUCLEAR, BIOLOGICAL, OR CHEMICAL ATTACK).

        F. ABRASIONS (UNLESS OF A SEVERITY TO BE INCAPACITATING).

        G. BRUISES (UNLESS CAUSED BY DIRECT IMPACT OF ENEMY WEAPON AND SEVERE ENOUGH TO REQUIRE TREATMENT BY A MEDICAL OFFICER).

        H. FIRST DEGREE BURNS.

        I. SOFT TISSUE INJURIES (E.G., LIGAMENT/TENDON/MUSCLE STRAINS OR SPRAINS).

        J. ANY WOUNDS/INJURIES RECEIVED AS A RESULT OF FRIENDLY FIRE WHEN THE INDIVIDUAL WAS NOT ENGAGING THE ENEMY AT THE TIME OF THE INJURY.

        9. AWARD OF THE PH FOR TBI.

        A. TBI ARE CLASSIFIED INTO THREE CATEGORIES BASED ON SEVERITY OF THE INJURY. IN DECREASING LEVELS OF SEVERITY, THESE CATEGORIES ARE: SEVERE/PENETRATING TBI; MODERATE TBI; AND MTBI.

        B. MTBI AND CONCUSSION ARE FREQUENTLY USED INTERCHANGEABLY. MTBI IS A MEDICAL TERM DEFINING THE PHYSICAL INJURY TO THE BRAIN FROM A BLOW OR BLAST. CONCUSSION IS THE LAYMAN TERM DESCRIBING IMPAIRMENT TO BRAIN FUNCTION (E.G., ALTERATION OF CONSCIOUSNESS, LOSS OF CONSCIOUSNESS (LOC), OR POST-TRAUMATIC AMNESIA) RESULTING FROM THE INJURY.

        C. DIAGNOSIS OF EITHER A SEVERE/PENETRATING TBI OR A MODERATE TBI NECESSARILY REQUIRES TREATMENT BY A MEDICAL OFFICER AND, THEREFORE, WILL QUALIFY FOR THE PH IF THE WOUND WAS THE DIRECT OR INDIRECT RESULT OF ENEMY ACTION.

        D. HOWEVER, THERE ARE VARYING SEVERITY LEVELS OF MTBI/CONCUSSIONS WHICH CAN PRODUCE SIGNS, SYMPTOMS, AND CLINICAL FINDINGS OF IMPAIRED BRAIN FUNCTION, RANGING FROM "SEEING STARS" AND DISORIENTATION TO POST-CONCUSSIVE AMNESIA AND LOC. ONLY THE MORE SEVERE INSTANCES OF MTBI/CONCUSSION WILL REQUIRE TREATMENT BY A MEDICAL OFFICER, AND THEREFORE QUALIFY FOR AWARD OF THE PH. EVEN THOUGH A MEDICAL OFFICER MAY BE REQUIRED TO EVALUATE THE SAILOR/MARINE BASED ON DISPLAYED SIGNS, SYMPTOMS, OR FINDINGS OF IMPAIRED BRAIN FUNCTION, SUCH EVALUATION DOES NOT IN ITSELF MEAN THE WOUND REQUIRED TREATMENT BY A MEDICAL OFFICER.

        E. RECENT RESEARCH INTO MTBI EFFECTS AND TREATMENT HAS LED TO A CLEARER UNDERSTANDING OF THE RELATIONSHIP BETWEEN THE SEVERITY OF AN MTBI AND THE TIME REQUIRED FOR BRAIN TISSUE TO RECOVER AND RETURN TO ITS NORMAL STATE. ALTHOUGH THERE IS CURRENTLY NO METHOD TO DIRECTLY MEASURE THE ACTUAL SEVERITY OF A MILD TRAUMATIC BRAIN INJURY, THE DURATION OF THE SIGNS, SYMPTOMS, OR CLINICAL FINDINGS OF IMPAIRED BRAIN FUNCTION SERVE AS A PROXY FOR ESTIMATING MTBI SEVERITY, AND THUS WHETHER THE MTBI MEETS THE PH THRESHOLD OF NECESSITATING TREATMENT BY A MEDICAL OFFICER. THE MOST MILD FORMS OF MTBI MAY RESULT IN LESS SEVERE COGNITIVE IMPAIRMENT LASTING ONLY MINUTES OR HOURS, WITH NO LASTING DAMAGE TO BRAIN TISSUE OR IMPAIRED BRAIN FUNCTION. IN THE MORE SEVERE CASES OF MTBI, THE LEVEL OF INJURY MAY RESULT IN IRREVERSIBLE DAMAGE TO BRAIN TISSUE WITH LONG TERM IMPAIRMENTS OF BRAIN FUNCTION. RESEARCH ALSO INDICATES THAT MANY SERVICE MEMBERS SUFFERING MTBI/CONCUSSIONS WITHOUT ANY LOC CAN HAVE SIGNS, SYMPTOMS, OR CLINICAL FINDINGS OF IMPAIRED BRAIN FUNCTION THAT LAST SIGNIFICANTLY LONGER THAN THOSE RESULTING FROM AN MTBI/CONCUSSION WITH LOC. FOR THESE REASONS, MILITARY NEUROLOGISTS NOW CONSIDER THE DURATION OF BRAIN FUNCTION IMPAIRMENT TO BE A MORE ACCURATE MEASUREMENT OF THE DEGREE OF BRAIN INJURY THAN WHETHER OR NOT A LOC OCCURRED.

        F. FOR THE REASONS CITED IN THE PRECEDING PARAGRAPHS, DEPT OF THE NAVY HAS UPDATED AND REVISED ITS STANDARDS FOR AWARDING THE PH FOR MTBI. SPECIFICALLY, AN MTBI/CONCUSSION WILL BE CONSIDERED SEVERE ENOUGH TO HAVE REQUIRED TREATMENT BY A MEDICAL OFFICER, AND THEREFORE MAY QUALIFY FOR THE PH:

        (1) WHEN THE SERVICE MEMBER SUFFERS A LOC OF ANY DURATION AS A RESULT OF A DIAGNOSED MTBI/CONCUSSION, OR

        (2) WHEN THE PERSISTENT SIGNS, SYMPTOMS, OR FINDINGS OF FUNCTIONAL IMPAIRMENT FROM A DIAGNOSED MTBI/CONCUSSION RESULT IN A MEDICAL OFFICER DISPOSITION OF "NOT FIT FOR FULL DUTY" FOR A PERIOD GREATER THAN 48 HOURS. THIS 48 HOUR RESTRICTION FROM RETURN TO FULL DUTY DOES NOT INCLUDE ASSIGNMENT TO ADMINISTRATIVE LIGHT DUTY BY A MEDICAL PROVIDER OR MEDICAL OFFICER IN THE ABSENCE OF PERSISTENT SYMPTOMS OF IMPAIRMENT FOR THE SOLE REASON OF COMPLIANCE WITH ADMINISTRATIVE SCREENING PROTOCOLS FOR CONCUSSIVE EVENTS.

        G. SIGNS, SYMPTOMS, OR FINDINGS OF BRAIN FUNCTION IMPAIRMENT MANIFEST WITHIN THE FIRST FEW DAYS AFTER SUFFERING AN MTBI/CONCUSSION. THEREFORE, A MEDICAL OFFICER OR CIVILIAN PHYSICIAN DIAGNOSIS WEEKS OR MONTHS AFTER A CONCUSSIVE INCIDENT, CITING ADDITIONAL OR MORE SEVERE SYMPTOMS OF BRAIN IMPAIRMENT THAN WERE DIAGNOSED DURING THE INITIAL SEVEN (7) DAY PERIOD FOLLOWING THE CONCUSSIVE EVENT, WILL NOT WARRANT AWARD OF THE PH. THIS RESTRICTION IS NECESSARY TO ENSURE THE PH IS NOT AWARDED FOR SYMPTOMS OF POST TRAUMATIC STRESS DISORDER (PTSD) THAT ARE SIMILAR TO THOSE OF MTBI/CONCUSSION, OR FOR A SUBSEQUENT CONCUSSIVE INJURY THAT WAS NOT THE RESULT OF ENEMY ACTION.

        10. PERSONNEL CASUALTY REPORT (PCR).

        A. COMMANDERS AT ALL LEVELS SHALL ENSURE THAT PCRS ARE SUBMITTED IAW REFERENCE F AND G (MARINE CORPS) AND REFERENCE H (NAVY), AND CONTAIN SUFFICIENT INFORMATION FOR THE PH APPROVING AUTHORITY TO DETERMINE IF THE WOUND/INJURY MET THE REQUIREMENTS FOR THE PH CONTAINED IN PARAGRAPH 2 ABOVE.

        B. THE COMMANDING OFFICER OF THE WOUNDED/INJURED SERVICE MEMBER MUST ENSURE THE PCR CONTAINS VERIFICATION FROM A MEDICAL OFFICER THAT THE WOUND/INJURY FOR WHICH THE MEMBER WAS TREATED REQUIRED TREATMENT BY A MEDICAL OFFICER, OR WOULD HAVE REQUIRED TREATMENT BY A MEDICAL OFFICER IF ONE HAD BEEN AVAILABLE PER PARAGRAPH 4 OF THIS ALNAV. A SUFFICIENTLY DETAILED DESCRIPTION OF THE WOUND/INJURY AND TREATMENT REQUIRED MUST BE PROVIDED TO SUPPORT THE OPINION OF THE MEDICAL OFFICER. PHRASES SUCH AS "TREATED BY COMPETENT MEDICAL AUTHORITY" DO NOT PROVIDE SUFFICIENT INFORMATION TO MAKE A DETERMINATION AS TO WHETHER THE WOUND/INJURY WAS OF A LEVEL OF SEVERITY TO REQUIRE TREATMENT BY A MEDICAL OFFICER, REGARDLESS OF WHETHER A MEDICAL OFFICER WAS AVAILABLE TO PROVIDE THE TREATMENT.

        11. RETROACTIVE AWARDS OF THE PH. THE UPDATED STANDARDS FOR AWARD OF THE PH FOR MTBI LISTED IN PARAGRAPHS 4.G AND 9.G OF THIS ALNAV ARE RETROACTIVE TO SEPTEMBER 11, 2001. PERSONNEL WHO SUFFERED A DIAGNOSED MTBI ON OR AFTER SEPTEMBER 11, 2001 THAT WAS THE DIRECT OR INDIRECT RESULT OF ENEMY ACTION, BUT WHO WERE NOT AWARDED THE PH FOR THAT MTBI (OR OTHER WOUND SUFFERED DURING THE SAME ACTION), MAY REQUEST RECONSIDERATION. REFERENCE F CONTAINS DETAILED RECONSIDERATION PROCEDURES FOR MARINES, AND FOR NAVY PERSONNEL WHO WERE SERVING IN MARINE CORPS UNITS AT THE TIME OF THE WOUND/INJURY. ALL OTHER NAVY PERSONNEL MAY REQUEST RECONSIDERATION BY CONTACTING THE OFFICE OF THE CHIEF OF NAVAL OPERATIONS (CODE DNS-35), 2000 NAVY PENTAGON, WASHINGTON, DC 20350-2000.

        12. THIS ALNAV IS APPLICABLE TO THE TOTAL FORCE NAVY AND MARINE CORPS.

        13. RELEASED BY RAY MABUS, SECRETARY OF THE NAVY.

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