Not necessarily, the MOCs can send “ranked” slates or unranked slates. If they rank, obviously the #1 candidate would get the slot if fully qualified (and that is a big “if” on the medical side.) If the #1 in not qualified, then it moves on to #2 etc… But, USNA has the final say and for instance if #1 and #2 already gave LOAs then the academy could “charge” them to another source and all of a sudden #3 is charged tho the MOC. And, remember your DS does have a nom. and if “fully qualified“ will be placed on the Natl. Wait List where several hundred qualified candidates are offered appointments each year. The MOCs only control their choice for who is charged to them but not the hundreds of other spots for offers of appointment. In a class of 1,100 -1,200 there are only 535 MOCs so there are many more offers given then just those slate winners. Don’t be discouraged! As you say he is #3 on one list and I have seen several slates where the top 3 or 4 get medically DQed or select other schools, or don‘t pass a CFA, etc.. I don’t know where your DS is with medical, etc.. but keep moving forward - always have the plan “B” but in some competitive states (like where I am in VA) you can have even 5 or 6 on the same senate slate ALL get offers of appointment in the same year! Tell DS to hang in there, enjoy his senior year, and thanks for his willingness to serve! Good luck….