Qualifier: I deployed as a battalion S1 (human resources officer) whose responsibilities included the awards program for over 300 service members in three military branches.
There is a distinction if you know what to look for. Medals with "Star" or "Cross" in the name require action in a combat zone. Medals with "Service" in the name generally do not. Notable: The Distinguished Service Cross (Army award for valor second only to the Medal of Honor) is a combat medal that meets the first criteria, but the name is confusing because of the word "Service" in the title. Note that there are many non-combat service medals that rank above the Bronze Star Medal. Below the BSM, the service-specific Commendation Medals are also awarded in combat zones and can be affixed with 'V' devices for valor.
To add confusion to the debate, non-combat awards, such as the Meritorious Service Medal (non-combat equivalent to the Bronze Star) and service-specific Achievement Medals, have been awarded in Iraq and Afghanistan to service members who work exclusively inside the wire. Guidance is vague enough to cause great inconsistencies in award approvals across commands, and many complaints from service members.
Adding new awards like this adds further confusion to what many consider to be an arbitrary and subjective process, and are usually only welcomed by the few service members who were not recognized by previously existing awards.