"Combat Service" Medal.

[CtahhR]

The "Combat Service" Medal («Մարտական Ծառայություն» Մեդալ) was founded on 26th November 1992 and is awarded to service personnel of the Nagorno-Karabakh Republic Defence Army, Police, National Security Service or other individuals who have contributed to the successful performance of combat missions, raising combat readiness of the forces, as well as for courage shown defending the state borders of the NKR. The Medal reads "Արիություն" (Courage) and is the second highest Medal of the NKR.
The population of the NKR is under 150,000 with a standing army of 20,000 swollen by universal two year conscription for 18 year olds.

Here is a Type 2 (Enamelled Suspension), made at the Saint Petersburg Mint and numbered 7578. Going by the extremely high serial number of this Medal I would suggest a 2014-15 award (Possibly for the 27th July – 8th August 2014 Armenia-Azerbaijan "Clash").