Tiffany Cross Medal of Honor The Tiffany Cross Medal of Honor arose immediately after World War I , as the US Navy decided to recognize via the Medal of Honor two manners of heroism , one in combat and one in the line of a sailor ' s profession . The original upside - down star was designated as the non - combat version and a new pattern of the medal pendant , in cross form , was designed by the Tiffany Company in 1919 . It was to be presented to a sailor or Marine who " in action involving actual conflict with the enemy , distinguish [ es ] himself conspicuously by gallantry and intrepidity at the risk of his life above and beyond the call of duty " and without detriment to his mission . This pendant became the " Tiffany Cross " . Description . The " Tiffany Cross " is suspended from the classic light blue Medal of Honor ribbon with 13 white stars . At the ribbon top is a bar with the word " VALOUR " . The medal is a gold cross pattée overlaying an oak and laurel wreath on the obverse side , with an antique anchor in each arm of the cross . The center , overlaying the cross , is an octagon with the phrases " UNITED STATES NAVY " to the top and " 1917 · 1918 " to the bottom , on the perimeter separated by two stars . The center of the octagon is the Great Seal of the United States . The reverse side is flat , suitable for engraving . Awardees ' medals often had intricate inscriptions . Authorization . On 4 February 1919 Congress , in the same act that created the Navy Cross and the Navy Distinguished Service Medal , Congress provided : Designed by Tiffany Company , this medal became the " Tiffany Cross " and eligibility was retroactive to 6 April 1917 , when the United States entered World War I . Inconsistent presentations . Despite the " actual conflict " guidelines , the " Tiffany Cross " was awarded to Floyd Bennett and Richard Byrd for arctic exploration , and to John Siegel for a rescue at sea . In the words of the Congressional Medal of Honor Society , the " Tiffany Cross " Program was " poorly regulated and documented . " Unpopularity and deauthorization . The " Tiffany Cross " was unpopular , perhaps because it so closely resembled the German Iron Cross . Recipients , such as Admiral Byrd , requested , received , and wore the classical inverted star design . Byrd received his " Tiffany Cross " on 27 February 1927 from President Coolidge . He received his classical Medal of Honor on 20 June 1930 from President Hoover . His motives for the change are not remarked upon . In 1942 , the Navy returned to using only the original 1862 inverted 5 - point star design , and ceased issuing the award for non - combat action . Next lower award . During the " Tiffany Cross ' s " active status , the next lower naval award was the Navy Distinguished Service Medal , followed by the Navy Cross . By congressional action on 7 August 1942 , in the same act that terminated the " Tiffany Cross " , the Distinguished Service Medal and the Navy Cross swapped places , with the Navy Cross also becoming solely a combat award . List . The US Naval History & Heritage Command asserts that 28 sailors and Marines received the " Tiffany Cross " , but does not provide a list . However , a review of : make a nearly complete list . There are at least three recipients ( Byrd , Bennett , Siegal ) who have been awarded the " Tiffany Cross " for non - combat actions . There may be other in - period recipients that have also have received one , but these aren ' t known , and would require investigation of similar nature for each .