Army Spec. Donald P. Sloat’s brother William accepted the Medal of Honor on behalf of the fallen U.S. soldier on Monday, 44 years after he smothered a grenade blast in Vietnam to protect other members of squad. It’s the kind of selfless action that has routinely resulted in the nation’s top award for combat valor, and yet it took decades for Sloat to receive it.

The East Room of the White House was filled with many graying family members of both Sloat and retired Command Sgt. Maj. Bennie G. Adkins, 80, who also received the Medal of Honor during the ceremony. But sadly, Sloat’s biggest advocate couldn’t be there. The soldier’s mother Evelyn had died three years ago, after making it her mission to see her son’s actions recognized, President Obama said.

“But she always believed — she knew — that this day would come,” the president said. “She even bought a special dress to wear to this ceremony.”

For some, the belated ceremony again raises the question whether more heroes of the wars in Iraq and Afghanistan also could someday be recognized with the nation’s top valor award.  As noted in this previous Checkpoint post, there are numerous examples of modern service members whose extreme heroism were not recognized with the Medal of Honor. In a few of those cases, the commanding officers who could have nominated them for the award have since expressed regret, raising the question of whether the cases should be reopened.

There’s perhaps no better example of this than the actions of Army Sgt. 1st Class Alwyn Cashe. On Oct. 17, 2005, he pulled six fellow soldiers from the burning wreckage of a burning Bradley Fighting Vehicle in Samarra, Iraq, suffering devastating burns in the process. His fuel-drenched uniform intensified the danger he was in, but he continued to make trips into the vehicle until his work was done. He died a few weeks later on Nov. 8.

Cashe’s battalion commander at the time, now-Brig. Gen. Gary Brito, recommended the soldier for the Silver Star, a prestigious award that is nevertheless two notches below the Medal of Honor in recognizing heroism on the battlefield. Brito later said that he did not realize the pain and suffering involved in his actions, and has decided to fight to get Cashe’s award upgraded.

Harry Conner, a family spokesman also involved in the Cashe lobbying effort, said the family has never made demands, and is grateful for Brito’s effort. But the Cashes do believe their fallen soldier’s actions have not received the appropriate award, and feel some frustration “due solely to the years this process has taken,” Conner said.

That has some similarities to the Sloat and Adkins cases. In both instances, they received the Medal of Honor only after lobbying campaigns were mounted, and as stories of their extreme heroism were shared widely. But the Medal of Honor captures the American imagination like no other combat valor award, and U.S. officials eventually decided to right “a mistake,” as an official Army account of Sloat’s award upgrade put it.

Until recently, Sloat was never nominated for a valor award for his final sacrifice because his commanders were not informed of it, the Army said. On June 6, 2011, Sen. Tom Coburn (R.-Okla.) wrote a letter to the service requested that it review a new award nomination, dated June 3, 2011, from Sloat’s old platoon leader, Army officials said. The service began processing it, but it still required special congressional approval because of the time that had lapsed.

Adkins was originally awarded the Distinguished Service Cross, second only to the Medal of Honor in awarding valor in combat, on April 30, 1967. On April 21, 2011, Rep. Mike Rogers (R.-Mich.) wrote on behalf of Adkins’ former superior officers, retired Col. John D. Blair IV and retired Master Sgt. Donald Turner, asking that the Army consider upgrading the award due to “new, substantive and relevant information that was not previously available,” Army officials said.

The Pentagon launched a broad review of the awards process in June at the direction of Defense Secretary Chuck Hagel. It will last about a year, and is focused in part on whether “the program adequately recognizes all levels of combat valor,” said Navy Lt. Cmdr. Nate Christensen, a Defense Department spokesman.

The review was initiated after Hagel apologized last year to Army Capt. William D. Swenson, who received the Medal of Honor in October 2013 after his case was bungled by the Army. His ceremony came four years after he braved enemy fire numerous times on Sept. 8, 2009, in Afghanistan to carry a fellow soldier who had sustained a gunshot wound from harm, and then search for four missing service members who had been killed. He was first recommended for the Medal of Honor in December 2009, but his digital nomination packet went missing and the case went cold for two years.

Pentagon officials did not say whether cases like Cashe’s could get another look as a result of the Pentagon’s ongoing review of the awards process. But it’s something his family and fellow soldiers certainly desire.

“I don’t know that there’s much more I can do,” Brito said in an Army news account in July. “I’ve asked others who have provided witness statements so far to look at them and see if there’s anything else that can be recalled that was left off before. I’m not going to have anything fabricated and I’m not going to violate the integrity of the award, and I don’t want to bring any dishonor on Sgt. 1st Class Cashe or his family.”

UPDATE: Sept. 18, 1:50 p.m.: This post has been updated with additional information from the Army about the circumstances of the Medal of Honor cases for both Sloat and Adkins. Previous information in this post attributed to another news organization was incorrect, Army officials said.