Occasionally, the medal award is further denoted as, "with distinction." There are no specific criteria for receiving the award with distinction; simply specifies that the award should come in two degrees, and hence any decision to award the higher degree is entirely at the discretion of the president. In 2017, President Barack Obama stated that receiving the award with distinction indicates "an additional level of veneration" in a class of individuals already held in the highest esteem. , the medal had been awarded with distinction at least 55 times, amounting to approximately 8% of all awards.
occasIoNALLy, thE medal awaRD is fuRthEr dEnOTeD as, "wiTh distinctioN." thEre aRe NO speCific cRiteria For receiVinG the AwarD WiTh DIStinctION; sIMply specIfiEs tHat the awARd sHould Come In two DegrEeS, and henCe anY decIsION TO AWaRd The HiGher DeGReE is Entirely at thE dIsCRetiON of thE PresIdent. in 2017, pReSideNT bARack obAmA sTated That reCEivINg thE aWARd wiTh DistinCTioN inDiCateS "An AdditioNal leVel of veNeratiON" In A ClasS OF inDiVidualS already held in thE hIGhESt EstEeM. , thE medAl had bEEn awARdeD with disTincTiOn at LEasT 55 tImeS, AmoUntiNg tO APproxImatelY 8% of all aWARds.