This book traces the legislative and administrative history of the Medal of Honor (hereafter, "Medal") since the establishment of separate Navy and Army medals in the Civil War. Though filled with tales of heroism, its sober, lawyerly narrative will appeal more to scholars than to general readers.

Army veteran and historian Dwight Mears PhD, JD, frames his study as a kind of legal history, based on legislative measures, court cases, Congressional reports and documents, and military regulations. Besides archival material, he uses relevant news reports and the like in considering recent events. Mears refers to public pressure for various actions, but his sourcing for this is thin, featuring NY Times articles and a few other non-government sources. The literature about the Medal amounts mostly to retelling the exploits of the same notable recipients.

The book comprises two parts. The first recounts the legal and policy history of the Medal. The second concerns exceptions to the rules made via legislative and other means. Noting the absence of medals before the Civil War, Mears parses the muddled language of the various Medal acts—formal or informal—passed during the war. He clarifies patterns of who received awards for what actions from 1865 up to 1917 when the Army formally "purged" Medals, revoking over nine hundred of them. He then reconstructs how the creation of other, lesser medals for gallantry and distinguished service affected how the Medal was awarded in the First World War, with attention to postwar efforts to equalize awards made to naval and army personnel. The Navy's discrepant policy of making awards for non-combat actions and to commanders who had not been personally gallant was not rectified until after World War II. The author notes as well, without comment, that far fewer non-posthumous Medals were awarded after the war. Mears spends little time discussing the Air Force and has no problems with its procedures.

Part II concerns awards requiring exceptional procedures, for instance, extending the period of eligibility after a conflict or (likely illicitly) waiving other stipulations. As an example, Charles Lindbergh received a Medal for his (non-wartime) solo trans-Atlantic flight, when he was not even on active duty. Congress later ruled out bills seeking the Medal for particular individuals or knowingly breaking with procedure in order to appease constituents or allow military departments to take action before Congress did.

Mears also looks at the Boards for the Correction of Military Records, which could upgrade awards or take action when recommendations were lost or ignored. Two Medals purged in 1917 were restored to Civil War surgeon Dr. Mary Edwards Walker (1832–1919) and showman William "Buffalo Bill" Cody (1846–1917). Mears disapproves in both cases, since neither had served unambiguously in the US Army. Because Edwards was (at that time) famous as the only female recipient of the Medal, Mears deals with her at length in his chapter on restorations:

The book's final chapters examine how the Administrative Procedures Act has pressured the government to act consistently; it has also addressed lesser medals awarded to African Americans, Asian Americans, and religious-minority service members—groups historically discriminated against. A brief conclusion precedes a 30-page appendix summarizing all legislation regarding the Medal of Honor.

Dwight Mears's The Medal of Honor is a useful and meticulous (if somewhat dry) survey of the criteria and procedures for awarding Medals. Too often, however, it explains how rather than why the military changed its criteria or Congress its laws in response to what specific public expectations. Perhaps that would have entailed a more speculative cultural approach than Mears has adopted in his fine legal history of the Medal of Honor.