<p>The third "Q" in triple Q'd is for Physical aptitude (PAO), not for nomination.</p>
<p>LOA's are issued based on Scholastic quals only and have nothing to do with the other 2 Q's, except that an LOA is really pointless if you already have everything done (triple Q'd and Nomination). So LOA's are issued to let you know they want you, but you have to finish your part to actually get an appointment out of it.</p>