IMHO Awards at that level reach the political realm.
I know an LTC (SF) who was told that if he was ijured, there's a good hance he'd have been awarded the MoH vicethe DSC. He's very modest about the whole thing...("I was just doing my job...you'd have done the same given that stuation.") Look him in the eye and you can tell he means it. He's that humble about it.
It's not unheard of for awards to get upgraded years later based on a lobby of friends, family, or action group to the politicians. One example was the award of an MoH to an African American for action in WWII. Someone applied the common sense test and said "You can't tell me that out of all the African Americans that served in WWII, not ONE had actions that merited the MoH?" The concluded something wasn't right (the climate back then), reviewed the awards for valor back then and upgraded a valor recipient to MoH. I saw the details on 60 minutes IIRC a couple years ago. I apologze, his name escapes me.
EDITED TO ADD: http://www.cnn.com/US/9701/13/medal/
Link courtesy of another ps member's google-fu.
The political climate drives much of this. Politics both in and out of the military.
Some senior officers pride themselves on the lack of awards they approve. "I only awrded it to guys I'M sure earned it." Good to be sure...but don't you trust the commanders that are making recommendations to you?
The flip side is also not desirable... handing out awards like candy...which clearly denigrates the awards.
Like anything in llife, balance is the key.