Former president Donald Trump has sparked a sharp backlashamong veterans and Democrats by saying that an award recognizing civilian contributions to society is “much better” than one bestowed on members of the military because many of those who receive that award are wounded or killed in combat.

Trump made the remark during a pro-Israel event in New Jersey where he was introduced by Miriam Adelson, a top Republican donor whom Trump awardedthe Presidential Medal of Freedom when he was president in 2018. Trump said it was the “equivalent of the Congressional Medal of Honor but civilian version.”

The Medal of Honor is reserved for only the most outstanding acts of valor on a battlefield by military members. The Presidential Medal of Freedom, which is considered the highest U.S. civilian award, has historically gone to people for their significant contributions to society, with no specific criteria required.

“It’s actually much better because everyone gets the Congressional Medal of Honor,’ Trump said. “They’re soldiers. They’re either in very bad shape because they’ve been hit so many times by bullets or they’re dead. [Adelson] gets it, and she’s a healthy beautiful woman. They’re rated equal, but she got the Presidential Medal of Freedom and she got it through committees and everything else.”

VoteVets, a group that supports Democratic veterans running for office, said Trump’s remark Thursday was not a “one-off insult of our Troops and our Veterans.”

“It isn’t just that Donald Trump doesn’t respect Veterans and their sacrifice,” the group said in a statement. “It’s that Donald Trump hates Veterans and their sacrifice, because he looks so small in comparison to them.”

Trump has previously made comments denigrating military members. His former chief of chief, John Kelly, confirmed last year that Trump privately disparaged dead service members as “suckers” and “losers” when Kelly worked for Trump. Trump has denied the account, which was first written about in a 2020 Atlantic story.

Vice President Kamala Harris’s campaign denounced Trump’s latest comment, saying in a statement Friday that he “knows nothing about service to anyone or anything but himself.”

“For him to insult Medal of Honor recipients, just as he has previously attacked Gold Star families, mocked prisoners of war, and referred to those who lost their lives in service to our country as ‘suckers’ and ‘losers,’ should remind all Americans that we owe it to our service members, our country, and our future to make sure Donald Trump is never our nation’s commander in chief again,” Biden campaign spokesperson Sarafina Chitika said.

Trump’s campaign did not immediately respond to a request for comment on the Democratic criticism of his comment.

Trump has long stirred outrage with comments denigrating military service. Early in his first presidential campaign, in 2015, Trump said the late Sen. John McCain (R-Ariz.), a prisoner of war in Vietnam, was not a war hero “because he was captured.”

“I like people who weren’t captured,’ Trump said.

The latest Trump comment also comes as his campaign criticizes how Harris’s running mate, Minnesota Gov. Tim Walz (D), has characterized his own military service over the years. Trump’s running mate — JD Vance, an Ohio senator and Marine veteran — campaigned Thursday in Pennsylvania with fellow veterans in Congress who took issue with how Walz has described his service.

Walz served for more than two decades in the Army National Guard but did not serve in combat, according to the Minnesota Army National Guard. Republicans have called out comments he made in 2018 suggesting he served in war; a campaign spokesperson has acknowledged he “misspoke.”

After Harris’s campaign on Thursday appeared to reject Vance’s proposal for a second debate with Walz, Vance responded with a dig at Walz’s service.

“Walz refuses to deploy!” Vance said on X.

The Presidential Medal of Freedom has long gone to prominent cultural figures and political allies of the president. Trump awarded it to icons that included NBA Hall of Famer Jerry West and musician Elvis Presley, but also several political allies, including Rep. Jim Jordan (R.-Ohio) and then-Rep. Devin Nunes (R.-Calif.), who is now chief executive officer of the Trump Media and Technology Group.

During his 2020 State of the Union address, Trump announced he was giving the award to Rush Limbaugh, the conservative radio commentator who attended the speech after a diagnosis with lung cancer. Limbaugh died in 2021.

Modern standards, adopted in 1963 during the Vietnam War, require that Medal of Honor recipients distinguish themselves “conspicuously by gallantry and intrepidity at the risk of life above and beyond the call of duty,” with actions that often inspire awe in those who witness them.

The Medal of Honor is sometimes mistakenly referred to as the “Congressional Medal of Honor,” as Trump did Thursday.

Many acts of valor, including those earned under enemy gunfire, do not qualify, and can instead receive other awards that are considered a step or two lower but still prestigious. Among those are the Distinguished Service Cross, the Silver Star, and the Bronze Star with V device, denoting valor. Service members and veterans have voiced frustration on numerous occasions that military officials have determined that acts of valor that they witnessed did not meet the criteria for the Medal of Honor.

By law, a nomination for a Medal of Honor must be submitted within three years of an act of valor, and the approval process must be complete within five years. But that requirement can be waived with congressional approval, typically when new information emerges.

Each Medal of Honor case requires evidence, typically witness statements and corroborating information such as video, recorded radio transmissions, maps and even autopsy results. Nominations are typically submitted by a commanding officer and must work their way through a multi-tier approval process through a U.S. troop’s branch of service, to a service secretary, the defense secretary, and ultimately the president.