Well then, I shall post a few of my thoughts on the matter.
The ideal of the Pendant of Blood as a award of skill is a noble one. It is of this opinion that I personally favour. However, it cannot be denied that the current Pendant of Blood can be earned without the competitive skill in combat, but rather repeated grinding.
Of course, in any said game, no matter what, we must look at the larger whole. As, let us take a look at Jedi Knight: Jedi Academy. Said players can repeatedly spar against only people of lesser skill repeatedly, or the same exact person constantly on a day to day basis. They can then rack up quite a few wins, and earn a Pendant of Blood.
We can also look at Pazaak. It is something that takes quite much less input than Jedi Academy. It is a basic, generalized card game from Star Wars, and one that I do not personally like.
ToR is a MMORPG. MMORPG's are not the sort of games that require much, if any skill in general play. Of course, their are certain players who can break the game down(Such as Runescapes turn based ticks, and calculating upon that), the mathematical formula of a MMORPG...The carefully built Character, weapon switching, and what not. However, it is much less a competitive game than lets say, Quake, and more of a generalized game to appeal to the masses. Something that is easy for people to get into without much of a learning curve, lots of "Rewards", and what not. MMORPG's ultimately are something in which one can wait while for the most efficient ways of doing things are discovered, research, and repeat. Nothing is of course wrong with this, but they are quite linear grindfests. I sincerely doubt a lot of players genuinely break the game down to a more mathematical level, as some people do in these games at the highest levels, and even the reward for breaking the game down is quite little in general mainstream play.
Star Craft is a competitive game. Completely competitive, it is a sport in numerous countries with massive tournaments with monetary awards. Very excellent as a game.
Of course, I do understand your question. Your asking for their to be a difference between the Generalized PVP award, and a award of a higher tier, something of absolute excellence in relation to competitive play against players. However, the "Grinding", or the award that you seek will not have the absolute value due to the above which i said. Of course, awards and medals do mean quite little. Its all about the fun :P.
Of course, of what kind of excellence? How much is a award worth ultimately? A "Unskilled" player in relation to PVP can still obtain the "New PVP award" by what I have said before. Trying to create some sort of medal for the higher level you are thinking of, in which it has the implied value of what you want, requires more than simply another medal. It requires a set community in a set game of competitive standards that are constantly being pushed up, and the people in said community being challenged daily. Such a thing would increase the worth of X award.
Too long to read? Grinding can exist in any game, and all games. Even StarCraft. The value of such a award is not in the award itself, but rather the people and or the community surrounding it, or the tasks. I recall ToR has some sort of PVP, as well as said other games. However, I am going to withdraw myself a bit. All games played, one can play all games and technically grind, or play "Skillfully".
Ultimately, just some random feedback I thought I would provide in rant form. If you earned a PoB through skillful play, it will have immense value. If otherwise, is it cheapened or less? You decide, I report! Artistic News!
Anywhose. ./End rant. I just woke up. A higher end medal would require said system of competitive play to have the "Supreme value of Excellence". ./Me Shrugs. Ultimately, its all ego. Medals/Pixels. Very pretty, very nice, but the value is in the person themselves. The people matter the most, and are awesome. Feedback is interesting in all organizations, but one should be able to look past such things and into the heart of the matter and people, and gain the true value of playing a game/With other people/Etc.
Flow with what is.