My local district committee has a tradition of taking up a collection every year to make a West donation in the name of a Scouter who has gone above and beyond in their dedication to Scouting. The planned recipient is not told of the honor, and all discussion happens via emails sent seperate from any meetings. This seems to me about as close to "earning" a James West knot as you can get. I'm one of the newest committee members, so I don't have any expectations of getting one, but if it did happen to me sometime in the future I would gladly accept the recognition and add the knot to my uniform. I haven't been around long enough to know what happens if they can't find a worthy recipient or if they fail to raise the funds needed.