MELISSA BLOCK, host:

This is ALL THINGS CONSIDERED from NPR News. I'm Melissa Block.

For generations, the U.S. military has awarded Purple Hearts to soldiers wounded in action. But as we reported today on MORNING EDITION, an investigation by NPR and ProPublica has found that Army commanders routinely deny Purple Hearts to soldiers who've suffered concussions from explosions. That's even though Army regulations say those injuries do merit the award.

Now, the story of five soldiers who have struggled to get not only Purple Hearts, but also medical help. Their saga reveals that some commanders still don't believe that brain injuries are just that - injuries.

NPR's Daniel Zwerdling has our story, which he reported with T. Christian Miller of ProPublica.

DANIEL ZWERDLING: It was January 16th last year, Baghdad, 8 p.m. Some soldiers were hanging out in their housing trailer at Camp Liberty. We call them the Baghdad Five.

Sergeant DERRICK JUNGE (U.S. Army): I was on the phone with my wife on Skype Web cam.

Sergeant JARED HOLLINGSHEAD (U.S. Army): We had come off a patrol.

Sergeant JAMES HOPKINS (U.S. Army): The trailer that we were in, of the three rooms, we were in the middle room.

ZWERDLING: These are Derrick Junge, Jared Hollingshead and James Hopkins. As they told their stories, Junge was in Tennessee; Hopkins was in Kansas; Hollingshead was in Texas. The two others in the Baghdad Five didn't give us interviews.

Sgt. JUNGE: I was laying down on my bed with the computer on my chest.

Sgt. HOLLINGSHEAD: The rest of us were standing in the back part. And I was sitting down in a chair.

Sgt. HOPKINS: They were playing Xbox.

Sgt. JUNGE: It was "Call of Duty 4" - basically, a shoot-em-up game.

Sgt. HOLLINGSHEAD: And then the explosion.

Sgt. HOPKINS: What I do remember is a bright flash of light.

Sgt. JUNGE: One second, everything's normal. The next second...

(Soundbite of finger snap)

Sgt. HOLLINGSHEAD: The sound was beyond words, enormous.

Sgt. HOPKINS: Probably the most heart-wrenching thing you'll ever go through.

Sgt. JUNGE: I don't really know what to compare it to.

Sgt. HOLLINGSHEAD: Lights are falling off the ceiling.

Sgt. HOPKINS: It was just utter terror.

Sgt. JUNGE: Dust everywhere.

Sgt. HOLLINGSHEAD: Smoky.

Sgt. HOPKINS: I can't see anything because it's so dark.

Sgt. JUNGE: Dark.

Sgt. HOLLINGSHEAD: The next thing I remember, I was on the floor.

Sgt. HOPKINS: I'm getting helped up off the floor.

Sgt. JUNGE: I don't remember feeling a shockwave. I don't remember hearing a blast.

Sgt. HOLLINGSHEAD: Kind of everything - kind of goes blank after that.

Sgt. HOPKINS: And then I had yelled out loud: Is everybody okay?

ZWERDLING: And amazingly, everybody was alive. A rocket had exploded just outside their trailer. Shrapnel tore through the walls. But only one man actually got hit - shrapnel in his legs. But over the next few days, almost everybody felt: Something's wrong in my head.

Sgt. JUNGE: I wasn't able to walk. Like, I was stumbling.

Sgt. HOLLINGSHEAD: Shaking.

Sgt. JUNGE: Couldn't keep my balance.

Sgt. HOLLINGSHEAD: Just a constant headache.

Sgt. JUNGE: Piercing headaches.

Sgt. HOPKINS: Your head would be throbbing so bad.

Sgt. HOLLINGSHEAD: Somebody would be talking directly to me...

Sgt. JUNGE: I'd be in the middle of saying something, and forget what I was saying.

Sgt. HOLLINGSHEAD: And I wouldn't recall what they had just said to me.

Sgt. HOPKINS: And they were giving us briefings, but I just could not remember it.

ZWERDLING: The Army's own studies show that many soldiers who've suffered concussions from explosions have never been diagnosed. But in this case, a brain specialist just happened to be in Baghdad when the rocket exploded.

Dr. MICHAEL RUSSELL (U.S. Army): My name is Dr. Michael Russell. I'm a lieutenant colonel in the United States Army. I'm the senior neuropsychologist for the Army Medical Command.

ZWERDLING: And Russell examined the Baghdad Five, who'd been in the trailer.

Dr. RUSSELL: These people are examples of concussion from pure blast.

ZWERDLING: Research shows that the blast wave from an explosion shoots through walls. The blast wave shoots through brains, and damages the brain's cells and circuits. Doctors call it mild traumatic brain injury or TBI or concussion -they're interchangeable.

Dr. RUSSELL: Actually, when you work a lot with acute concussion, you actually kind of recognize the look of a person who's been acutely concussed. It's kind of a dazed expression, a little bit slow to respond. The last thing they remember is they were playing video games. The next thing they remember, they're outside the trailer, in a shelter. So that's post-traumatic amnesia, and that's your classic symptoms of a concussion.

ZWERDLING: Russell wrote it all down on the soldiers' medical records. So their officers told them: you're going to get Purple Hearts.

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ZWERDLING: The military has awarded Purple Hearts to soldiers who get wounded in action since the 1930s. Here's a newsreel from the Korean War.

(Soundbite of newsreel)

Unidentified Man #1: The Purple Heart award is only an indirect expression of the real appreciation of a grateful nation.

General PETER CHIARELLI: And a soldier who receives a concussion documented by a doctor, diagnosed by a doctor, should receive the Purple Heart.

ZWERDLING: That's the vice chief of staff of the U.S. Army, General Peter Chiarelli. He was quoting the official Purple Heart regulations.

Gen. CHIARELLI: It's quite clear. The Army regulation is very, very specific in stating that concussion caused by enemy action entitles a soldier to a Purple Heart.

ZWERDLING: But here it is, 20 months since that rocket attack in Baghdad. And none of the five soldiers who suffered traumatic brain injuries has received the Purple Heart. With one exception - the guy who got a shrapnel wound got the Purple Heart for that.

What was your reaction?

Captain MARK GUELICH: (U.S. Army) I'm sorry, a concussion is internal but still, you have signs that the blast caused it.

ZWERDLING: Captain Mark Guelich was the soldiers' commander at Camp Liberty. He says all the soldiers who got concussions deserved the Purple Heart. He's seen how TBIs affect his troops.

Capt. GUELICH: It affects them a lot. And if they don't get treated, they get worse. And so a guy should get that Purple Heart.

ZWERDLING: So we asked the Army, why didn't they?

We've been trying to find what we thought would be a very simple answer to a very simple question: Which generals refused to give the Purple Hearts to the soldiers we've interviewed?

Lieutenant Colonel STEWART STEPHENSON (U.S. Army): I'm not going to discuss an individual soldier's case.

ZWERDLING: We were meeting with Lieutenant Colonel Stewart Stephenson. He runs the military awards branch. The way things typically work, the officer who supervises the wounded soldier submits his or her name for a Purple Heart - and Captain Guelich did that for all the Baghdad Five. Then ultimately, a general has to approve or reject the awards.

But we weren't just asking Stephenson why the Baghdad Five didn't get Purple Hearts. We've talked to more than a dozen other soldiers across the country who got diagnosed with concussions from explosions. They haven't received Purple Hearts, either.

Lt. Col. STEPHENSON: It would be inappropriate for us to discuss a specific chain of command, a specific decision, the reasons why, or a specific policy that might be being utilized in theater.

ZWERDLING: But we obtained a recording of a top Army researcher speaking frankly with colleagues. And he told them one reason why so many soldiers with concussions have essentially been ignored.

Dr. RODNEY COLDRON (U.S. Army): Another issue that we found in Iraq as far as underdiagnosis is the issue of the Purple Heart.

ZWERDLING: That's Dr. Rodney Coldron. Coldron was part of an Army team that studied TBIs last year in Iraq. And they presented their findings to the National Academy of Neuropsychology. Coldron wouldn't give us an interview, but the academy recorded what he told their meeting about TBI and Purple Hearts.

Dr. COLDRON: There was a push by the higher-level commands to not be seen to be giving these out for just any old injury.

ZWERDLING: And we obtained internal Army emails which confirmed that. These emails show that starting a few years ago, some top medical commanders in Iraq told colleagues: No more John Kerrys. John Kerry, of course, is the Democratic senator who got three Purple Hearts when he fought in Vietnam. His political opponents have mocked him - unjustifiably, it turns out - because they claim he got one of the awards for a scratch.

So when commanders say no more John Kerrys, they're saying most traumatic brain injuries are not real injuries. They dismiss them.

Dr. COLDRON: Any old injury.

ZWERDLING: And that mindset has become official policy.

A general named Joseph Caravalho took over the medical system in Iraq in 2008. And Caravalho wrote that in many cases, soldiers will not get Purple Hearts if they only get quote, minimum medical intervention, unquote, for their TBIs. That small phrase, minimum intervention, was a huge change because the Army's official regulations just say the wound needs to require treatment in order to get the Purple Heart. It doesn't say how much treatment you need to get for a bullet wound or a shrapnel wound or any other injury.

So Caravalho's language makes it much tougher to get a Purple Heart for a concussion. We took this memo to the Army's vice chief of staff.

General, would you read the...

Gen. CHIARELLI: Yeah. The specific clause, it says Purple Hearts...

ZWERDLING: General Peter Chiarelli has a sprawling office in the inner ring of the Pentagon. He held the memo up in the air.

Were you aware of this memo before yesterday or today?

Gen. CHIARELLI: No. I'm going to look into all of this. I mean, this is a good catch. I find this document contradictory in what it says. I am not the final authority. I need to have lawyers look at this, and I need to talk with them downrange to make sure that we're following the Army regulation.

ZWERDLING: Sergeant Hollingshead, what does it say to you that the Army still has not given you a Purple Heart?

Sgt. HOLLINGSHEAD: I kind of have to watch my language on this one, but I just think it's crap.

ZWERDLING: If anybody doubts that a concussion is an injury, they should visit Jared Hollingshead, and the rest of the Baghdad Five.

Sgt. HOLLINGSHEAD: I mean, to not give somebody an award that they deserve, it's un-American - because we weren't missing an arm or a leg, a couple of fingers. But I think the brain is just as important. If it's injured, it's injured.

ZWERDLING: Hollingshead left the Army early this year. His contract was up. Now he and his wife, Lena, live in a house surrounded by pines near Marshall, Texas. They say he gets terrible headaches every day. He reads a sentence in his gun magazines, and can't remember what he read.

Ms. LENA HOLLINGSHEAD: And sometimes he's like - during a conversation we talk about one topic and then all of a sudden, he switches to something else. And he says, what were we talking about? That's weird. Yeah, he didn't do that before.

ZWERDLING: Sergeant Hollingshead, you stayed in the Army for another year after this explosion. Did any medical person ever come to you and say, you might need some sort of intensive rehabilitation?

Sgt. HOLLINGSHEAD: Nobody ever came back to us to follow up. It was pretty much: Just go to work.

ZWERDLING: And talk to Derrick Junge and his wife, Holly.

Unidentified Child: ...has been bad.

ZWERDLING: We met the Junges and their children in a rented house near Fort Campbell. Holly says the kids have been acting out ever since Junge came home late last year.

Unidentified Child: Get off my desk.

Ms. HOLLY JUNGE: Hey, focus. Look at me. Indoor voice.

Unidentified Child: (unintelligible)

Ms. JUNGE: Thank you.

ZWERDLING: Derrick Junge used to be a mechanic on the stealth bomber. But since the explosion last year in Baghdad, he can't remember the names of household objects.

Ms. JUNGE: He's not himself. His memory is just horrible. You know, I mean...

ZWERDLING: This is really hard for you to talk about.

Ms. JUNGE: You'd realize how much it affects me, I guess.

ZWERDLING: Did Derrick used to have a good memory?

Ms. JUNGE: Oh yeah. He had - everything about him was wonderful. You know, not that it's not now, it's just different. It's just different now.

ZWERDLING: When you think of the way your brain and the way you function used to be, as 10, where are you now since the explosion?

Mr. JUNGE: I would like to think that I'm still a 10. But I used to be - I don't know, I guess you could say I used to be a different person. I would probably -maybe put myself somewhere around a 7.

Ms. JUNGE: I would say 4. I would say a 4. That's what I would say - just being honest.

ZWERDLING: Junge filled out forms at his base, saying he's had problems since the explosion. And nobody in the Army has followed up. And the Army has never sent him a Purple Heart. In fact, it's as if nothing happened to Derrick Junge that night last year in Baghdad. The Army is sending him to Afghanistan any day now. Junge will lead a platoon in America's main war.

Daniel Zwerdling, NPR News.

BLOCK: You can read more about TBI, and the history of Purple Hearts, at NPR.org and ProPublica.org. Transcript provided by NPR, Copyright NPR.