Donald Trump appeared to denigrate service members who were injured or killed in the line of duty once again, as he likened a civilian award to a “better” version of the Medal of Honor at a campaign event on Thursday.

At an event on antisemitism at his Bedminster golf club, the former president and presidential candidate was introduced by Miriam Adelson, a powerful financial force in Republican politics and the widow of the late GOP megadonor Sheldon Adelson. As he took the mic, the former president spoke highly of the couple and recalled awarding her the Presidential Medal of Freedom in 2018, an act that sparked criticism at the time that Trump was rewarding a donor for their financial support.

“That’s the highest award you can get as a civilian. It’s the equivalent of the Congressional Medal of Honor, but civilian version,” Trump said, referring to the Medal of Honor, a military award.

“It’s actually much better because everyone [who] gets the Congressional Medal of Honor, they’re soldiers. They’re either in very bad shape because they’ve been hit so many times by bullets, or they’re dead,” Trump said. “She gets it, and she’s a healthy, beautiful woman. And they’re rated equal, but she got the Presidential Medal of Freedom, and she got it for — and that’s through committees and everything else.”

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The GOP presidential nominee’s off-the-cuff comments on Thursday follow a pattern of insulting veterans and service members, even as he claims to be a fierce supporter of the military. He has called military leaders “some of the dumbest people I’ve ever met in my life” and minimized potentially traumatic brain injuries among service members. In 2015, he infamously attacked Sen. John McCain for being detained in a North Vietnamese prison, saying he liked “people who weren’t captured.” He also picked a personal fight with family members of a U.S. soldier who died while serving in Iraq.

Trump has also long disputed a report from The Atlantic that he called service members who died in wars “losers” and “suckers,” though his former White House chief of staff John Kelly has confirmed some aspects of it.