in 2011, the department of defense changed its awards manual regulations concerning the medal of honor, specifying that the "v" device instead of the oak leaf cluster and inch star would be used to denote additional citations in the rare event of a service member being awarded a second moh. by may 2015, the department of defense changed its awards manual again concerning the medal of honor, specifying that a separate moh is presented to an individual for each succeeding act that justifies an award. there has not been a living repeat medal of honor recipient since the world war i era, so the "v" device was never actually worn in this fashion.