On May 2, 1968, while serving as Commanding Officer, Company E, 2nd Battalion, 4th Marines, Livingston distinguished himself above and beyond the call of duty in action against enemy forces during the Battle of Dai Do, and earned the Medal of Honor.

He was next assigned as the Assistant Chief of Staff for Operations and Training at the Marine Recruit Depot, Parris Island, South Carolina.

[3] He was also a political supporter of Jeb Bush and in December 2015 was featured in an ad called "Honor" in which he referred to President Barack Obama as a "Commander-in-Chief [who] requires training wheels.

He later endorsed Donald Trump in the 2024 election in a letter with dozens of other flag officers stating that a Biden presidency would lead to Marxist control of America"[4] He wrote his autobiography, Noble Warrior: The Story of Maj. Gen. James E. Livingston, Medal of Honor.

[5] Livingston's decorations and awards include: The President of the United States in the name of The Congress takes pleasure in presenting the MEDAL OF HONOR to

Skillfully employing screening agents, Captain Livingston maneuvered his men to assault positions across 500 meters of dangerous open rice paddy while under intense enemy fire.

Although twice painfully wounded by grenade fragments, he refused medical treatment and courageously led his men in the destruction of over 100 mutually supporting bunkers, driving the remaining enemy from their positions, and relieving the pressure on the stranded Marine company.

Wounded a third time and unable to walk, he steadfastly remained in a dangerously exposed area, deploying his men to more tenable positions and supervising the evacuation of casualties.

Coordinating with the commander of the second company, he then led his unit forward under cover of supporting air strikes and again was halted by the hostile fire.

Observing a third company commence an assault against the enemy's flank, Captain Livingston, completely disregarded his own safety as he jumped to his feet during a heavy rocket attack, rallied his men and led them in an aggressive charge against the North Vietnamese positions.

By his courage, gallant leadership and selfless devotion to duty at great personal risk, Captain Livingston upheld the highest traditions of the Marine Corps and of the United States Naval Service.