The President authorized the Army Distinguished Service Medal on January 2, 1918. It is awarded to persons who distinguished themselves by exceptionally meritorious service to the government in a duty of great responsibility. The award may be given for either combatant or noncombatant service. As a noncombatant award it has been given to many well-known historical figures, including Marshal Foch, General Pétain, Field Marshal Haig and General Pershing.

In the precedence of awards it ranks under the Medal of Honor and the Distinguished Service Cross. It was designed by Captain Aymar Embury, who also designed the Distinguished Service Cross. It may be awarded posthumously. Additional awards are indicated by bronze oak leaf clusters.