Assuming he is medically qualified, it is quite rare to get an LOA and not a nomination and thus an appointment. Each member of congress is allowed to present 10 names each as nominees. Now, there's a lot of "IFs" when it comes to just because you have a nomination, how do you go the next step as far as getting an appointment. With an LOA, those "Ifs" go out the window. The LOA, by the nature of it's name, means "LETTER OF ASSURANCE" Therefor, you are ASSURED an appointment, IF you are medically qualified and have a nomination. (They wouldn't have given out an LOA if you hadn't satisfied ALL other requirements). So, being you are assured, it doesn't matter what type of nomination you get. All the "Ifs" about nominations are also gone. Meaning, it doesn't matter if you are the Primary nominee ranked #1 on the MOC's list, or is you are their last #10 choice. Doesn't matter if it's the representative's nomination or your Senator's. Doesn't matter if it's a presidential, ROTC, or any other type of nomination. You simply need a nomination.
So, back to your question. The only way you wouldn't get a nomination, is if your MOC doesn't give you one. You MOC should have been notified that you have an LOA. But sometimes, this isn't always true. So, what should you do?
1. Did you have the LOA PRIOR to your nomination interviews?
2. If YES, did you inform your MOC that you had an LOA?
3. If you didn't have the LOA at the time of the interview, did you contact them sense the interview to tell them that you have an LOA; and that if you get a nomination, then you are assured an appointment?
4. SPEAK WITH YOUR MOC. Mind you, it's unlikely you will speak with them personally. They have people who work for them who are in charge of this areas. Contact that person and ASK QUESTIONS.
But the nomination is totally in their hands. If you are eligible for OTHER nominations, such as presidential, ROTC, etc... then the academy can help get you another nomination in case your MOC simply won't nominate you. But if all you are eligible for is a MOC nomination, then the academy doesn't have any say over that at all. You need to be on your MOC's slate of 10 names. Doesn't matter which of the 3 MOC members. Doesn't matter in which order. Doesn't matter where on the slate. But you MUST be on at least one of those slates. If you are somewhere on it, and have an LOA, and passed your DODMRB, then you get an appointment. It's really that simple. best of luck... mike.....