This is a single-light image. The gentleman was sitting in an arm-chair in his living room. The walls (3-4' behind him) were light-coloured and there was average daytime ambient light in the room. To get this lighting, I first metered the ambient lighting and used a combination of low ISO and small aperture to achieve an almost black scene. I don't recall the numbers off-hand, but let's say for example that was: ISO 100 and f8 (shutter speed is irrelevant as long as it's below sync speed since I'm using flash).
I used a large (22") gridded beauty dish immediately camera left and close enough to the subject so that the rim was visible in the original frame. The speedlight was set to give me f8 on his face and the gridded dish aimed so that there was no spill on the background. There would have been a bright patch lower down on the wall/floor camera right, however I didn't care about that as I knew I could crop it out.
With the light that close, the fall-off was great enough that his medals were actually about one stop below his face, however I adjusted that in post.