and three acorns, and below this, around the outside edge of the medal, is the inscription, United States Armed Forces. Additional awards and devices Subsequent awards of the Humanitarian Service Medal are denoted by wearing a bronze service star on the HSM suspension and service ribbon. A silver service star is worn in lieu of five bronze service stars. Approved operations Below is a list of approved operations in accordance with the Department of Defense. References 1977 establishments in the United States Awards established in 1977 Humanitarian and service awards United States service medals