The current version of the medal was established in February 2003, retroactive to March 1, 2002.

The decoration was originally established as the Transportation Distinguished Service Medal by Executive Order 12824, signed by President George H. W. Bush on December 7, 1992.

On April 5, 2011, President Barack Obama amended Executive Order 12824, as amended, modifying the award eligibility from "a member of the Coast Guard" to "any member of the Armed Forces of the United States".

[3] As a distinguished service medal, this decoration is one of the highest awards that can be bestowed upon a member of the U.S. Armed Forces.

The medal may be awarded to any member of the Armed Forces of the United States.