The Army is considering more than doubling the number of Purple Heart medals awarded to soldiers wounded in the Iranian ballistic missile attack on their base in Iraq in January 2020, an attack the Trump administration downplayed as concerns swirled about an escalating conflict.

In the weeks after the attack, the Trump administration sought to diminish the injuries troops had suffered. It wasn't until more than a month after the attack that the Pentagon acknowledged that more than 100 troops had suffered traumatic brain injuries from the 13 missiles that slammed into the base.

About 80 troops involved in the attack submitted paperwork for the Purple Heart, the medal awarded to troops killed or wounded by enemy action. Of those 80 troops, the military awarded 30 Purple Hearts.

Col. Gregory Fix, the commander at the time, submitted Purple Heart paperwork for 56 soldiers in January 2020.

"Before submission, I conducted an extensive review of each Purple Heart award package to ensure compliance ... My Brigade Surgeon, Colonel Jonson, who personally treated each Soldier injured in the attacks, also reviewed each medical record to ensure all injuries were properly documented," Fix wrote last month in a memo obtained by USA TODAY. He said he was told to issue four of 23 Purple Hearts in February 2020 but was instructed not to inquire about or resubmit the awards for the other 33 soldiers.

The Army now anticipates receiving 39 more submissions for Purple Heart medals and will process them under existing regulations, Lt. Col. Gabe Ramirez, an Army spokesman, said on Tuesday.

“The U.S. Army’s Human Resources Command recently received a number of Purple Heart nominations related to the Jan. 8, 2020 Al Asad Air Base attack," Ramirez said in a statement. "HRC routinely processes award nominations submitted from units, soldiers, veterans and family members from as far back as (World War I)."

Beyond its symbolism, the Purple Heart carries entitlements that include priority health care upon retirement from the Veterans Affairs Department, preferences in hiring for federal jobs and eligibility for burial at Arlington National Cemetery.

A soldier who suffered a brain injury and an official who surveyed the damage described the missile attack as intense and a miracle that it didn't kill any troops. But it has left the soldier and others with injuries that linger nearly two years later. Both the soldier and official say commanders discouraged wounded troops from filing paperwork for the Purple Heart.

Invisible wounds

At the time, President Donald Trump was dismissive when asked about the wounds during a news conference.

"I don’t consider them very serious injuries, relative to other injuries that I’ve seen," Trump said after the attack. "No, I do not consider that to be bad injuries."

Complicating the issue is the nature of traumatic brain injuries, which are not as obvious as a lost limb from a bomb explosion. Brain injuries may qualify troops for a Purple Heart when the injuries are documented by a medical officer. But even the Pentagon struggles to count the wound accurately, according to a recent inspector general report, which found estimates still vary as to how many troops suffered brain injuries in the attack.

A statement from U.S. Central Command in 2020 noted that traumatic brain injuries do not automatically qualify troops for the award and the process for determining eligibility "was designed to be a fair and impartial proceeding that evaluated each case in accordance with applicable regulations."

Revenge for Soleimani, a soldier's goodbye to his daughter

The missile attack from Iran followed the Jan. 2, 2020, U.S. drone strike near Baghdad's airport that killed Gen. Qasem Soleimani, leader of Iran's elite Quds Force, part of the country's hard-line paramilitary Revolutionary Guard Corps. U.S. officials characterized his killing as defensive, saying Soleimani had been planning attacks on American diplomats and troops.

Iran responded six days later by firing ballistic missiles at Ain al-Asad base in western Iraq where hundreds of U.S. troops had been stationed. Intelligence reports had given U.S. troops hours of advance notice that the missile attack was coming, according to a soldier who was not authorized to speak publicly about the attack or the wounds he suffered.

The soldier had been writing a farewell letter to his daughter when the alarm sounded that missiles would strike within minutes. The first volley of three rounds rocked his building, enveloping everybody in dust, he said.

The explosions broke windows more than a mile away from the missiles' impact, according to a Defense official, who also was not authorized to speak publicly. It was a miracle that nobody was killed even with the advance warning, the official said. Unlike smaller rocket attacks launched by Iranian-backed militias on U.S. bases in Iraq, the blast from theater missiles sent dangerous shock waves across the base, the official said.

The days after the attack were fraught and busy, the soldier at Ain al Asad recalled. Worry persisted that Iran could attack again, the U.S. could launch a retaliatory strike, or that Iraq would rescind its welcome, requiring U.S. troops to evacuate immediately. The soldier and others returned to duty despite suffering headaches. He was told later that not being treated immediately meant that he and several others wouldn't qualify for the award.

The soldier and some of his colleagues continued to experience headaches, anger issues and slurred speech, he said. Yet doctors and commanders were reluctant to categorize them as wartime casualties, he said, and discouraged him from filing the necessary paperwork.

A board convened by the task force overseeing operations in Iraq determined who qualified for the Purple Heart from the attack.

Further muddying the issue is confusion within the Pentagon about how many troops suffered brain injuries in the attack. Central Command reported that 110 troops had brain injuries, while a separate office that tracks such wounds counted 87 troops with the wound from the same attack, according to the Defense Department's Inspector General.

The soldier, who in his 30s continues to take medication for his brain injury, said receiving the Purple Heart would signify formal recognition that he was wounded in combat and help make things right.