President John F. Kennedy established the current decoration in 1963 through , with unique and distinctive insignia, vastly expanded purpose, and far higher prestige. It was the first U.S. civilian neck decoration and, in the grade of Awarded With Distinction, is the only U.S. sash and star decoration (the Chief Commander degree of the Legion of Merit—which may only be awarded to foreign heads of state—is a star decoration but without a sash). The executive order calls for the medal to be awarded annually on or around July 4, and at other convenient times as chosen by the president, but it has not been awarded every year (e.g., 2001, 2010). Recipients are selected by the president, either on the president's own initiative or based on recommendations. The order establishing the medal also expanded the size and the responsibilities of the Distinguished Civilian Service Awards Board so it could serve as a major source of such recommendations.