The award is based on recommendations from other flight surgeons, aviators or the chain of command.
Strain has served in the armed forces for 25 years in both the National Guard and U.S. Army. He was deployed to Iraq in 1991 as part of Operation Desert Storm and then returned as a guardsman in 2005 to 2006, while attached to an infantry brigade, and again in 2010 to 2011 when he was attached to the Task Force 1-171 General Support Aviation Battalion.
While Strain is proud of serving in two branches of the armed forces, and said "you wouldn't probably find a more staunch advocate" of the military, he prefers to focus on his recent accomplishments as a flight surgeon, rather than focus on his days as a sergeant.
"I'm proud of being an enlisted guy, but I don't try to rehash it too much," Strain said. "I pick up when I was commissioned as a P.A. in '98."
Although the award recognizes him for being a flight surgeon, Strain explained that he is actually a physician assistant rather than a doctor. However, in the military, both doctors and physician assistants are called flight surgeons.
Physician assistants go to the same school as physicians, Strain explained, so they receive similar training that qualifies them as flight surgeons. In addition, physician assistants are easier to find for military duty, as doctors are often busy and have shorter deployments.
Physician assistants, Strain added, are also "a little more expendable."
Flight surgeons monitor the medical condition of their unit and also inspect aircraft life support systems. This includes such things as lifesaving equipment on board or any medical equipment the aircraft carries. The flight surgeon also performs routine care for the unit. If there is a medical evacuation the flight surgeon is a part of it, as they have more medical knowledge and experience than the unit's medic.
While under Strain's care, the 1-171st GSAB's pilots flew more than 25,000 hours of aeromedical evacuation missions, soldier and cargo transport missions and command aviation transport missions.
Strain said it was "nice" to be selected as a flight surgeon for his last deployment, but he almost decided to put off his deployment date.
Just days before deploying to Iraq, his wife gave birth to twin boys that were 15 weeks premature and each weighed barely more than a pound. Strain considered staying home to care for his family, but was persuaded to leave when fellow guardsmen, and his own family, gave him support.
"Fellow guardsmen would stop what they were doing to go and pray with my family or provide support," Strain said in a written statement after receiving the award. "So this deployment was a success story due to the support I felt both here in Georgia and deployed in Iraq. So this award is theirs as much as it is mine."
Strain is glad he deployed when he did. If he had put off his deployment he would be leaving now, when both his sons are a year old.
"Now that I'm home I'm getting to enjoy it," he said.
Strain has built up enough deployment time that he should not be gone for another three or four years, and he is happy to spend that time at home with his family.
"They're the most important thing to me, more than an award," he said. "The recognition of my family and what I have here far exceeds a piece of paper."