The NATO Medal was first established in 1996 to recognize individuals who had served in the Implementation Force (IFOR) as part of Operation Joint Endeavor in Former Yugoslavia.

United States Armed Forces regulations do not permit the wearing of operation bars on the NATO Medal ribbon.

There are currently fourteen versions of the NATO Medal in existence, for service in the former Yugoslavia, Kosovo, North Macedonia, two for service during Article 5 operations (Eagle Assist, Active Endeavour), and eight for Non-Article 5 NATO operations (International Security Assistance Force Afghanistan (ISAF), Resolute Support, Balkans, NATO Training Mission-Iraq (NTM-I), Africa, AMIS, OUP-Libya, and Pakistan).

The Medal is the personal award of the Secretary General of NATO, who signs each citation.

When assessing nominations for the award, there are several criteria taken into consideration: the performance of acts of courage in difficult or dangerous circumstances; showing exceptional leadership or personal example; making an outstanding individual contribution to a NATO sponsored programme or activity; or enduring particular hardship or deprivation in the interest of NATO.

The NATO Meritorious Service Medal is now authorized for wear on U.S., Canadian and British military uniforms.

[9] For Canadian and U.S. military members, the NATO MSM is considered a foreign personal decoration and would be placed in the order of receipt within that category, followed by foreign unit awards, then non-U.S. service and campaign awards (such as the standard NATO Medal).

To differentiate between the versions of the NATO Medal, a different ribbon pattern scheme is used for each of the decorations.

The NATO Meritorious Service Medal consists of a blue background with gold, silver and three narrow white stripes on each outer most portion of the ribbon, and the medallion color is changed from bronze in appearance to a silver medallion for this medal only.

The Balkans area is delineated as the political boundaries and airspace of Bosnia and Herzegovina, Croatia, Yugoslavia (including Kosovo), the Republic of North Macedonia, and Albania, based on the detailed description contained in the SFOR, KFOR, and Task Force Fox Operational Plans.

[13][14] NATO campaign medals where a British decoration has not been issued, such as the award for Operation Unified Protector, may be worn.

On 24 July 2012, the United States Department of Defense announced that NATO medals for operations in Libya and Africa have been approved for acceptance and wear by eligible U.S. service members and DOD civilian personnel.