The Distinguished Service Medal was created by an act of the United States Congress on July 6, 1960 and was first awarded in 1965.

However, as is customary for most military decorations, the requirements for the Distinguished Service Medal are interpreted more liberally when awarded upon retirement.

Cases of the award of this decoration to an individual who was not a general officer, or the Chief Master Sergeant of the Air Force, are unusual.

[4][5] Recipients during the medal's first 6 years included General Emmett E. "Rosie" O'Donnell Jr. (a United States Air Force four-star general who served as Commander in Chief, Pacific Air Forces from 1959 to 1963).

O'Donnell also led the first B-29 Superfortress attack upon Tokyo during World War II after the 1942 Doolittle Raid.