And there's the rub, or part of it. PTSD doesn't typically, or necessarily, include 'giving blood,' and therefore is not regarded as constituting a sacrifice deserving of the nation's 'reverence.' That'd be one big impediment. In fact, soldiers asked about it have said they believe awarding the PH for PTSD would "cheapen" the award. A story in The Army Times last year contained the following complaints:
"It would lessen the meaning of the award,” a Marine said about the military’s oldest combat medal.
“I’d be ashamed to wear it,” chimed in a soldier.
“It’s an insult to those who have suffered real injury on the battlefield,” wrote an Army intelligence officer.
Then one would need to consider the attitudes of the "Brass." The military brass, no matter what noises they might make to the contrary, ALWAYS regard "PTSD," "combat fatigue," "shell shock," etc., to be forms of malingering, mere excuses from the duty ALL faced, whether in terror-induced psychoses or not.
The Brass, the pols, the bureaucracy may fake a certain sympathy for the victims of PTSD/Shell Shock, but behind it is unrelieved scorn: "Tough Guys" don't break down like little girls at the sight of a few dead bodies, or from getting blown up a little. Succumbing to PTSD/combat fatique is a sign of inherent weakness. And anyone who is so delicate as to be unable to continue in their duties is unworthy of the trust of their buddies, because they might collapse in a crisis, and in combat, one fights not for god, nor country, nor flag, nor even the girl back home; one fights FOR one's buddies, one's shipmates, one's pals.
So there will be no Purple Heart for the PTSD victims. It would be too much like honoring what those who award the medal regard as borderline cowardice...
Of course, they've got their heads up their asses.
But when was THAT any kind of abnormality among the Military Bosses?