The only goal came from forward Josh Sweeney, who scored on a breakaway 9 minutes 28 seconds into the second period by planting the puck just over the left shoulder of Russian goalie Vladimir Kamantcev.
It was just his second goal of the tournament but ultimately became the goal that won not just the game but the Games.
The States had a solid second chance to score with just over a minute left in the second period, when Joshua Pauls took the puck down the ice on a breakaway but was blocked by a fantastic save by Kamantcev.
Shots on goal were low for both teams, with just four for the United States and six for Russia.
That meant Steve Cash, the U.S. goalie whose great saves in these Games have earned him the nickname "Cash Money," took a bit of a back seat for most of the game, save for a crucial save with just over half a minute left in the final period.
Russia wasn't able to capitalize on a number of chances, failing to complete their passes and losing the race down the ice to pick up loose pucks.
As the third period ran down, the Americans controlled the puck in the middle of the ice did a good job of running down the clock, controlling the puck in the middle of the ice.
The stands were filled with Russian fans cheering loudly and waving large Russia flags to support the end of their team's first appearance at a Paralympic Games.
It is also the first time a team has defended the sledge gold medal.
Both teams, plus third-place Canada, received their medals directly following the game.
While some of the Canadians looked a bit dejected, and others, including Tyler McGregor cried openly, captain Greg Westlake took a moment to mug for the camera, lightening the mood of those around him. Goalie Corbin Watson got a big cheer when his name was called, and let out a loud whoop after receiving his medal.
The loudest cheers were saved for the Russians, unsurprisingly, before the United States players received their medals and their anthem was played.