I think in the game it generally requires an extrondanairy feat, such as sinking a fleet carrier or a Yamota battleship, and even at that, it is much easier to win than it would have been in real life. It would be very hard to simulate an action in a sub sim worthy of a Medal of Honor, since this was awarded for extreme bravery and self-sacrifice. As said abouve, the majority of those who have won it (including submariners) did not survive the action for which the medal was awarded
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