The medal recognizes service by personnel in various career fields who have served in units involved with national strategic nuclear deterrence operations.

The establishment of the Nuclear Deterrence Operations Service Medal was announced by Secretary of the Air Force Deborah Lee James on 27 May 2014.

[4] The creation of this medal is part of a multifaceted approach to attract and retain high-caliber personnel in the nuclear and missile operations career fields.

[5] The idea for this medal had been circulating within the Air Force for a few years prior to approval, with confirmation as early as 2011 that work was ongoing to develop this award.

Per AFI 36-2803 para A2.4.2.3.3, this device will be worn by airmen who meet one of the following criteria: A) Dispatched to a missile complex for 179 non-consecutive days in direct support of Intercontinental Ballistic Missile operations, and performed duties in one of the following Air Force Specialty Codes:[2] B) for nuclear laden aircraft: nuclear certified aircrew, aircraft maintenance technicians, munitions maintenance technicians, combat crew communications, nuclear certified controllers, and security forces performing guard duties.