The medal was created on November 6, 1942, by Executive Order 9265[2] issued by President Franklin D. Roosevelt.

There were 21 Army and 48 Navy-Marine Corps official campaigns of the Pacific Theater, denoted on the suspension and service ribbon of the medal by service stars which also were called "battle stars"; some Navy construction battalion units issued the medal with Arabic numerals.

The Arrowhead device is authorized for those campaigns which involved participation in amphibious assault landings.

The Fleet Marine Force Combat Operation Insignia is also authorized for wear on the medal for Navy service members who participated in combat while assigned to a Marine Corps unit.

A full medal was authorized in 1947, the first of which was presented to General of the Army Douglas MacArthur.