In 2017, President Barack Obama stated that receiving the award with distinction indicates "an additional level of veneration"[5] in a class of individuals already held in the highest esteem.

[7] President John F. Kennedy established the presidential version of the decoration in 1963 through Executive Order 11085 (signed February 22, 1963), with unique and distinctive insignia, vastly expanded purpose, and far higher prestige.

[10] The order establishing the medal also expanded the size and the responsibilities of the Distinguished Civilian Service Awards Board so it could serve as a major source of such recommendations.

A special and rarely granted award, called the Presidential Medal of Freedom with Distinction,[16] has a larger version of the same badge, which is worn as a star on the left chest.

It comes with a sash that is worn over the right shoulder (similarly to the Grand Cross of an order of chivalry), with its rosette (blue with a white edge, bearing the central disc of the badge at its center) resting on the left hip.

When the medal with Distinction is awarded, the star may be presented hanging from a neck ribbon and can be identified by its size, which is larger than the standard badge.