What separates the Army Distinguished Service medal (DSM) from most others is that it can be awarded to anyone—military or civilian, U.S. citizen or foreigner—who has shown exceptionally meritorious service in a duty of great responsibility while serving the U.S. Army in any capacity. Recipients include filmmaker Frank Capra, British Prime Minister Sir Winston Churchill, Chinese Gen. Chiang Kai-shek, suffragette Anna Howard Shaw, actor James Stewart, and test pilot Chuck Yeager. (There is a caveat for potential DSM recipients who are not members of the Armed Forces of the United States: they can be awarded the medal only for their services during wartime.)

However, since the medal is principally given to high-ranking officers, recipients primarily include generals and admirals, including Bradley, Doolittle, Haig, Halsey, Marshall, Mitchell, Montgomery, Nimitz, Patton, Pershing, Powell, and Schwarzkopf. Douglas MacArthur and Dwight Eisenhower were awarded five each, which remained the record until General Martin Dempsey received his sixth Army DSM in 2015.

This fourth-highest military award was authorized in 1918 in the same legislation that established the Distinguished Service Cross and the Silver Star. Each branch of the military has its own DSM, and a fifth version is a senior award given by the Department of Defense.

In March 2017, the Army announced the establishment of the “C” combat device and authorized it for wear on the DSM and five other Army medals. Designed to recognize especially meritorious service or achievement under combat conditions that occurred after 7 January 2016, the “C” device cannot be awarded for simply being located in an area designated as a combat zone. Instead, the candidate must have been personally exposed to hostile action or have been in an area where other servicemembers were engaged. It does not require that the recipient was personally engaged with enemy forces.

The medal features the U.S. Coat of Arms in gold in the middle of a circle of dark blue enamel and is inscribed "For Distinguished Service MCMXVIII." On the back is the name of the recipient on a scroll superimposed on a trophy of flags and weapons. It hangs from a bar on a ribbon with a wide white stripe flanked by a scarlet stripe and a narrower ultramarine stripe.

Subsequent awards are denoted by oak leaf clusters.

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