This medal is a theater service award which is presented to those service members who engage in "significant activity" for which no other campaign or service medal is authorized. The term "significant activity" is determined by theater commanders and is normally deemed to be participation in a U.S. military operation considered to hold a high degree of scope, impact, and international significance that the operation warrants the presentation of a permanent service medal. Actions to be considered include peacekeeping operations, prolonged humanitarian actions, or military operations in support (or as a member of) NATO or United Nations forces.