The Medal of Horror was an Imperial starfighter pilot medal awarded for successfully completing ten tours of duty. The odd name seems like it may be based on the sheer amount of carnage expected for a soldier at this point. The name may also be a reference to the horrors an Imperial is expected to suffer with so much experience or a reference to what he has inflicted.
Specifically, the medal was awarded after the successful defeat of the Nami pirates and the destruction of their TIE/D Defender factory. It symbolizes the horror struck by the first usage of the Empire's latest starfighter - the Missile Boat.
The ribbon possessed red and blue stripes, as well as a yellow triangular center that prominently displayed the Imperial Crest in red. The medal itself was gold with silver and red patches, with the bottom most silver patch depicting a stylized blue bird in flight.