A recent call for change is gaining momentum after a letter from Marine combat veteran Nathan Fletcher was published by the Washington Post. Fletcher, now a professor at University of California San Diego, calls on policy makers in the DoD to hold mental injuries in the same regard as physical injuries.

Purple Heart is awarded to those wounded in combat

Current regulations require service members to be wounded or killed in battle in order to receive the Purple Heart. This has been limited to injuries that are visible, often leaving the veteran with permanent scars that serve as a reminder of their injuries.

Some surviving recipients of the award make full recoveries and are able to live perfectly normal lives after their wounds have healed. Others are left with permanent life changing injuries that require constant care, and some of the wounded must rely on prosthetic limbs for the rest of their lives. Both receive the same award.

Despite advancements, mental health evaluations still fall short

The diagnoses of Post Traumatic Stress Disorder (PTSD) can be given based on many factors including depression, hypervigilence, anxiety, guilt, trouble sleeping and experiencing flashbacks of a traumatic event.

The more we learn about the reality of mental illnesses the easier it is to treat these illnesses much like we would any other injury.

The argument of those against this proposal is due how broadly PTSD is diagnosed. An Iraq war veteran may find themselves depressed or suffering from anxiety but that may not be linked to any battlefield trauma. Some veterans are shocked when they have virtually no combat experience, yet the VA tells them they have PTSD.

Any amount of combat is no doubt a stressful experience, but not all stress from being in a combat zone should be considered combat stress.

Suicide rates among veterans are gaining national attention, yet not every veteran who commits suicide has experienced combat. While it is possible that receiving a Purple Heart will help veterans and assist the VA in treating veterans with mental illnesses, it is not likely that blanketing this award will help narrow down the unique circumstances that result in veterans ending their own lives.

Stigma in the veteran community

Despite the continued acceptances of mental health issues as a legitimate illness, many veterans and active duty service members still see mental illness as a sign of weakness. In a community where scars are worn as badges of honor the idea of someone bearing a mental scar is still considered by many to be a sign of weakness.

There is no doubt that the VA and many nonprofits are making significant progress in helping veterans overcome this stigma. Organizations like 22UntilNone and The Mendleton Foundation utilize social media to connect service members. The goal of these organizations is to maintain the sense of community that veterans experienced while they were actively serving while also providing them with a safe space to discuss their symptoms and reach out to other veterans when they find themselves falling victim to their invisible wounds.

There is no doubt that combat stress can, and often does, result in long term mental injuries. The VA often uses PTSD as a blanket diagnosis for veterans suffering from any number of mental health issues. This lack of specificity in individual cases makes it difficult to determine whether the veteran's mental health issue is related to direct combat or other factors. When awarding a Purple Heart for physical injury, the wound must be directly related to enemy action. This standard must also be applied in cases of mental injury.