You need both and you can't put yourself in for a PH. There has to be a paper trail. Dr. Letson treated Kerry. I don't know who wrote the medical treatment report, Dr. Letson or the corpsman present at the time. Very rarely are such reports written long after treatment. It is done contemperaneously. If Kerry shopped around for a phony report, then that would have a name on it. The point is that Kerry has not released any documentation on the first PH except the certificate. On the other two PHs, he released the after-action reports. A medical report alone is not sufficient. You have to document the injury came from hostile fire. Max Cleland was not entitled to a PH despite being a triple amputee.
From Unfit for Command: pp. 38-39
Q. How did Kerry get a Purple Heart from the incident then?
Grant Hibbard. I don't know. It beats me. I know I didn't recommend him for a Purple Heart. Kerry probably wrote up the paperwork and recommended himself, that's all I can figure out. If it ever came across my desk, I don't have any recollection of it. Kerry didn't get my signature. I said "no way" and told him to get out of my office.
"Amazingly, Kerry somehow "gamed the system" nearly three months later to obtain the Purple Heart that Hibbard had denied. How he obtained the award is unknown, since his refusal to execute Standard Form 180 means that whatever documents exist are known only to Kerry, the Department of Defense, and God. It is clear that there should be numerous other documents, but only a treatment record reflecting a scratch and a certificate signed three months later have been produced. There is, of course, no "after action" hostile fire or casualty report, as occurred in the case of every other instance of hostile fire or casualty. This is because there was no hostile fire, casualty, or action on this "most frightening night" of Kerry's Vietnam experience. Dr Louis Letson agreed with Grant Hibbard. Kerry's injury was minor and probably self-inflicted."
Thanks for the analysis. My suspicion is that he withheld the medical report in order to keep the corpsman on the signature from being identified. Where he would’ve gotten an after-action report remains a puzzle to me. Presumably if Kerry saw action that day others in his unit did as well, so it might be informative to see if anyone else in Kerry’s unit engaged in any documented combat that day. If Kerry has a Purple Heart from a day when no one else in his unit engaged in combat, that would be close to a smoking gun, I should think.