Since 2004, it has also been bestowed in lieu of the Bronze Star Medal for meritorious achievement in a designated combat theater.

[5] Normally, the acts or services rendered must be comparable to that required for the Legion of Merit but in a duty of lesser, though considerable, responsibility.

Within the U.S. Army, according to AR 600-8-22, Paragraph 3-17, the MSM may not be upgraded to or downgraded from a recommended Bronze Star Medal.

The U.S. Navy, U.S. Marine Corps, and U.S. Coast Guard subscribe to a slightly different philosophy from the Army, Air Force, and Space Force in awarding the MSM, typically reserving it for senior Navy and Coast Guard officers in pay grades O-5 to O-6 (commander and captain) and Marine Corps field grade officers in pay grades O-5 and O-6 (lieutenant colonel and colonel), with the first award of the MSM typically occurring after completion of a successful commanding officer assignment at the O-5 level.

Awarding the MSM to pay grade E-7 (e.g., USN/USCG chief petty officer and USMC gunnery sergeant) and below is very rare and by exception.

Additional awards of the Meritorious Service Medal are denoted by bronze oak leaf clusters in the Army, Air Force, and Space Force, with one silver oak leaf cluster denoting five additional awards.

As in 1968 when the MSM was created, there were concerns that the prestige of the BSM was also slipping during combat operations in Southwest Asia that had essentially been continuous since 1990.