The Purple Heart is the oldest U.S. military decoration, one that has not only changed in name, but also in purpose and award eligibility criteria.
During its 220-year existence, the Purple Heart, perhaps more than other military decorations, has reflected and continues to reflect the changing nature of warfare and, more importantly, the changing character of the nation that sends its men and women into harm's way. The changes, however, have not come without opposition and controversy.
The medal originated during the Revolutionary War, thanks to the personal efforts of Gen. George Washington who established the Badge of Military Merit to be awarded to Continental Army troops who displayed unusual acts of "gallantry, extraordinary fidelity and essential service" -- not necessarily including incurring wounds or injuries -- during combat.
The medal fell into disuse after the Revolutionary War and was brought back in 1932 by the Army as the Purple Heart, to be awarded to "anyone serving in the Army who had received combat-related injuries or had received the [Army Expeditionary Force's] Meritorious Service Citation Certificate during World War I, the latter criteria harkening back to the intent of George Washington's 'Badge of Military Merit.'"
On December 3, 1942, a year after Pearl Harbor, President Franklin D. Roosevelt issued an Executive Order authorizing the Purple Heart to sailors and Marines wounded or killed on or after December 6, 1941. At the same time the Legion of Merit medal was established for meritorious service, discontinuing the use of the Purple Heart as a merit award.
The criteria for the award of the Purple Heart, eligibility and applicability to the various military services have been periodically changed, broadened or restricted by executive orders, Congressional action and National Defense Authorization Acts.
For example, a 1984 amendment authorized award of the Purple Heart to those killed or wounded as a result of "an international terrorist attack," and "as part of a peacekeeping force" subsequent to March 1973.
Other changes expanding the eligibility criteria include the award of the Purple Heart to service members wounded while serving in any armed conflict in which the U.S. is engaged, even undeclared, for wounds received as a result of friendly fire and while held as prisoner of war or while being taken captive.
On the other hand, in 1997, Congress passed legislation prohibiting future awards of the Purple Heart to civilians.
When significant numbers of our troops began returning home from the battlefields in Iraq and Afghanistan suffering from Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injuries (TBI) -- often referred to as the "signature wounds" of those wars -- and the American people understood the grave nature of those injuries, a serious national debate started on the military's and the government's refusal to recognize PTSD and TBI as injuries of war and, consequently, the refusal to recognize those injuries as qualifying for the award of the Purple Heart.
Despite vigorous lobbying by U.S. military psychologists, medical experts and combat veterans, the Pentagon continued to block any such change in the Purple Heart award criteria well into the first term of Obama's presidency.
Indeed, military regulations specifically excluded PTSD as one of the injuries or wounds qualifying for award of the Purple Heart.
The debate has been heated. Some claimed, "It is disturbing that the Pentagon needs to see blood to establish the validity of a war injury," while others claimed that awarding the Purple Heart for depression or mental health disorders would cheapen the medal.
In 2011, the Army clarified its criteria for awarding the Purple Heart to soldiers suffering from enemy caused, blast-related concussion wounds like TBI, dropping the caveat for loss-of-consciousness and leaving discretion for awarding the Purple Heart to battlefield doctors who could diagnose the injuries properly.
In November 2011, Gen. Peter Chiarelli, the Army vice chief of staff told the PBS NewsHour that he would like to see PTSD called Post Traumatic Stress Injury, or PTSI, instead, as the term Post Traumatic Stress Disorder carries a stigma that has discouraged too many soldiers from understanding the condition and seeking proper treatment.
According to PBS:
"It is an injury," Chiarelli said. Calling the condition a "disorder" perpetuates a bias against the mental health illness and "has the connotation of being something that is a pre-existing problem that an individual has" before they came into the Army and "makes the person seem weak," he added.
In December 2011, the commandant of the Marine Corps expanded the eligibility for the Purple Heart to Marines who suffer a mild traumatic brain injury (mTBI) or concussion caused by enemy action if a medical officer makes a disposition that the Marine is not fit for full duty for more than 48 hours due to the persistent signs, symptoms, or findings of impairment from the concussion, provided the disposition was made within seven days of the event.
As was mentioned, members of the armed forces can receive the Purple Heart if they are killed or wounded as the result of an international terrorist attack against the United States.
"International" is the key word here.
But how about the military victims of a domestic terrorist attack, such as the 2009 Fort Hood, Texas, shootings by Army Maj. Nidal Malik Hasan that left 13 people dead and 32 wounded?
Rep. Peter King, R-N.Y. and Sen. Joe Lieberman, I-Conn., chairmen of their respective Homeland Security Committees, have introduced bills to expand the eligibility for the Purple Heart to include members of the armed forces killed or wounded in domestic terrorist attacks.
King's bill would remove the distinction between domestic and international terrorism by expanding eligibility to military victims of "a terrorist attack within the United States perpetrated by an individual or individuals expressing a political, religious or ideological obligation to engage in unlawful violence directed against United States military operations or foreign policy."
Expect additional changes as war and society evolve.