The medal was first awarded on 14 November 2008, to Marine Corps Lance Corporal James E. Swain, who died 15 November 2004, of wounds received while serving as a Marine Corps intelligence analyst during the Battle of Fallujah in Iraq.
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Second only to the National Intelligence Cross and the Intelligence Star among the intelligence community's awards for bravery, the medal is an authorized decoration for display on U.S. military uniforms, where it is worn after all U.S. military personal decorations and unit awards and before any military campaign/service awards and foreign decorations.
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