Also, no ribbon device is authorized for wear in AFI 36-2803 to denote subsequent awards of the CAM, which normally would be oak leaf clusters.
"[13] Gamble based the silver medal's design and ribbon color (scarlet with ten yellow stripes) from the circular insignia[14] painted on planes which were piloted by Brigadier General William "Billy" Mitchell, including a French-built SPAD XVI (SPAD 16) fighter aircraft he piloted in France during World War I.
[17] A laurel wreath surrounds the medal's eagle emblem executed in a simple, linear Art Deco style.
The eagle with a national flag shield with thirteen perpendicular stripes on its breast faces right, over the right talon clutching arrows (represents the power of war), to reflect that this is a combat medal.
The reverse side of the medal contains two rows of words written on a scroll at the center of the eagle, "U.S. Air Force" and "Combat Action".