The levels of accomplishment meriting this award may include a highly significant achievement in research, program direction, or program administration; a series of significant contributions; a continuing period of meritorious service; or an exhibition of great courage and heroics in an emergency.

[2] The PHS Meritorious Service Medall may also be awarded "With Valor", signified by a bronze "V" for recognizing acts of courage and bravery.

The designation “With Valor” is not to be used to recognize hazardous assignments or exposure to dangerous and life threatening environments.

The officer must exhibit a positive and particular act, or actions, of bravery and courage, and/or heroism, resulting in the saving or preserving of the life or health of others.

The degrees of risk to personal safety, the level of bravery, and the demonstration of courage, are determining factors that must be clearly displayed.