Some 3,500 Americans have received the Medal of Honor since it was first introduced in the 1860s, but to date, only 19 have earned the military’s highest award for valor on two occasions.

The first was Civil War cavalryman Thomas Ward Custer, younger brother of George Armstrong Custer, who received his medals for capturing Confederate flags and enemy soldiers on two separate occasions in April 1865. He later died alongside his brother at 1876’s Battle of Little Bighorn.

Nine more men received two Medals of Honor in the 19th century, including Robert Augustus Sweeney, an African American sailor who heroically saved shipmates from drowning in both 1881 and 1883. Four others were twice honored in the early 20th century during peacetime service as well as conflicts in Haiti, China and Mexico.

The five most recent double recipients all came during World War I, but each was technically honored twice for a single act of valor. The men were Marines working with the U.S. Army, and they received both the Navy and Army Medals of Honor for the same incident. Regulations now stipulate that soldiers cannot receive two citations for a single action.

Perhaps the most notable two-time Medal of Honor recipients are Smedley Butler and Dan Daly, both Marines who began their careers in the late-19th century before serving in World War I. Butler received his first medal for guiding his men through a firefight during U.S. involvement in the Mexican Revolution in 1914. He was later honored a second time during the American occupation of Haiti, and went on to achieve the rank of major general in 1929.

Dan Daly received his two Medals of Honor for actions in China and Haiti in 1900 and 1915. He later became one of the most famous servicemen of World War I for rescuing wounded troops and singlehandedly charging an enemy machine gun nest during the Battle of Belleau Wood. The actions earned Daly a recommendation for yet another Medal of Honor—a record third—but military brass ultimately opted for the Distinguished Service Cross instead.