<p>LOAs are given to the most competitive candidates. The number given out is very small and the overwhelming majority of candidates who receive appointments do NOT receive LOAs. Your goal should be doing your best to get an appointment, and if you get an LOA that’s an added bonus.</p>
<p>As for and LOA and medical issues – no relationship. To the best of my knowledge, if you are otherwise qualified for an appointment and CGO wants to offer you one, but you are still awaiting a medical waiver, the place will be “held” for you until that medical determination is made. </p>
<p>As for Presidential noms – not related to Medal of Honor or POW status. Here are the requirements per the usna.edu website: </p>
<p>"An unlimited number of presidential nominations are available for children and legally adopted children of career officer and enlisted personnel of the armed forces, active or reserve, including the Coast Guard. A parent in the reserve must be serving as a member of a reserve component and be credited with at least eight full years of service (a minimum of 2880 points) or must be entitled to retired pay except that he or she is not yet sixty years old. Otherwise, the parent must currently be on active duty (other than for training) and have served continuously for at least eight years or have been retired with pay or granted retired or retainer pay. "</p>
<p>The key is that there is an “unlimited number” of noms. They are not competitive – if you’re qualified, you get the nom. Thus, it is imperative that you apply to all other nom sources for which you’re eligible.</p>