A gold color metal and enamel device 1 1/8 inches (2.86 cm) in height overall consisting of a stylized gold caltrop upon a green equilateral triangle with, in base, a gold fleur-de-lis upon a red cross, and traversing the triangle a white wavy bar, all within a circular maroon scroll debruised by the top of the triangle and bearing the motto "READINESS WITH MERCY" in gold.
World War II action in Central Europe is represented by the green triangle which refers to the mountains of the Ardennes as well as the tents used by the predecessor organization for medical services and support during hostilities. The wavy white band represents the Rhineland, the Rhine River, and the winter snows of the region. France is represented by the fleur-de-lis. The gold caltrop, in the triangular form of the beechnut, symbolizes land war in Europe and recalls the beech forests of Ardennes-Alsace.
The distinctive unit insignia was originally approved for the 426th Medical Group on 8 November 1985. It was redesignated for the 426th Medical Brigade with the description and symbolism revised effective 16 September 1993.