Fallen Star Medal

The Fallen Star Medal is an item obtained in Silent Hill: Homecoming. It is one of three medals used to solve the Medal Puzzle in the Otherworld Shepherd House, it is located on a pedestal in the attic.

When examined, it is revealed that the Fallen Star Medal is awarded "For dereliction of duty". It likely references Adam Shepherd's failure to sacrifice his son Alex Shepherd and fulfill the family's pact with God.

Trivia

 * The Fallen Star appears to be modeled after the Medal of Honor, a decoration awarded by the United States Armed Forces for action "above the call of duty".
 * A likelier explanation, however, is that it's meant to be a Silver Star, or an inversion of a Silver Star. A memo reveals Adam received a Silver Star.
 * It has an image of a skull in the center with the word "FEAR" underneath.
 * When flipped upside down, the medal is a pentacle. A pentacle is essentially a pentagram encompassed by a circle, and although most prevalent in the Wiccan religion, is commonly perceived as a subject of evil worldwide. The pentacle is also a suit in some tarot packs, which are mentioned multiple times in Silent Hill 3.