Selection Procedures

2. Quality Review Sampling

Introduction

This topic describes the quality review sampling procedures, including

• selection procedures
• annual sample sizes
• rating end product (EP) review, and
• non-rating EP review.

Change Date

August 17, 2026

3.2.a. Selection Procedures

Each month, the Office of Performance Analysis and Integrity (PA&I) generates a list of end products (EPs) selected for national quality review for delivery to Quality Assurance (QA) via the Quality Management System (QMS). These EPs are randomly sampled from those completed during the previous month.

The total monthly sample for each RO includes both rating and non-rating EPs, allowing assessment of all essential claim adjudication actions.

3.2.b. Annual Sample Sizes

PA&I uses a statistical formula that considers both historical accuracy and workload values when determining valid rating and non-rating sample sizes for each RO.

QA provides annual sample size information on the QA STAR Reports intranet page.

Notes:

• Annual sample sizes are determined based on an average of two fiscal years’ worth of accuracy and workload data and are not subject to real-time adjustment.
• The annual sample is spread out over the course of the year so that there are enough EPs selected each month for every RO to have a statistically valid sample at the end of the year.
• Questions regarding either how cases are selected or how the sample size is determined should be referred to PA&I through appropriate channels.

3.2.c. Rating EP Review

Rating EPs are those associated with initial claims (including original claims, new claims, and claims for increase), reviews for hospitalization and routine future examinations, and supplemental claims. Rating reviews involve issues that are generally more complex and subject to greater scrutiny by stakeholders. Review of a rating EP is not limited to rating actions, but rather assesses the accuracy of all adjudicative actions leading up to the completion of that EP, with a focus on the outcome.

Compensation rating EPs subject to national quality review are

• 010 series - Original disability compensation, eight or more issues
• 020 series excluding 029 – New or increased disability compensation
• 040 series - Supplemental claim rating
• 110 series - Original disability compensation, seven or less issues
• 310 series excluding 314, and
• 320 series – Reviews due to hospitalization, and
• EP 335 – Blue Water Navy.

For DROC operations, the following EPs are selected subject to national review:

• 030 series - Higher-level review
• 030 series - PMC Board Grant Rating
• 030 series - PMC Higher-Level Review Rating
• 040 series - PMC Board DTA Error – w/IMO
• 040 series - PMC Board DTA Error
• 040 series - PMC Board DTA Error Rating
• 070 series - Post-certification control
• 170 series - Pre-certification appeal control

3.2.d. Non-Rating EP Review

Non-rating EPs are those that require development, review, and administrative decision or award action, but generally not a rating decision. However, if a rating decision is necessary to complete action on the EP, that decision will also be subject to review.

Compensation non-rating EPs subject to national quality review are

• 040 series - Supplemental claim non-rating
• 130 series - Disability and death dependency
• 163, 164, 165 - Accrued claims
• 290 series - Eligibility determinations, other, and
• 600 series - Pre-determination notice.

For DROC operations, the following EPs are selected subject to national review:

• 030 series - Higher-level review
• 030 series - PMC Board Grant Non-Rating
• 030 series - PMC Higher-Level Review Non-Rating
• 070 series - Post-certification control
• 170 series - Pre-certification control