What this means
m21-4:3.4 explains availability of review results. In plain terms, the official guidance says the national quality reports are updated monthly. Non-rating accuracy is reported on a claim-based level; rating accuracy is reported on an issue-based level. In accordance with standard statistical practice, VBA reports weighted accuracy results. It also addresses effective October 1, 2012, issue-based reviews are conducted in conjunction with the traditional compensation rating claim-based reviews.
How this may help with a claim
Use m21-4:3.4 as an internal VA audit trail for availability of review results, not as a promise of a particular result. Compare the actions recorded in your claim file or decision notice with this source-specific detail: The national quality reports are updated monthly. Non-rating accuracy is reported on a claim-based level; Effective October 1, 2012, issue-based reviews are conducted in conjunction with the traditional compensation rating claim-based reviews. If the record does not show the expected action, identify the missing step precisely when asking VA or an accredited representative to review the file.
What to review in your file
- Check the file against this official condition: Claim-based reviews assess accuracy based on the entirety of the claim. If one BE element of the claim is incorrect, the claim is marked as incorrect.
- Confirm that the record or notice addresses this source point: Issue-based accuracy is measured by individually evaluated medical contentions within a rating-related compensation claim.
- Document how this stated step or exception applies: Each issue must go through the same claims process that represents a series of completed tasks, such as development, research, adjudication, and decision, that could result in a specific benefit for a Veteran or survivor. More importantly, issue-based accuracy provides VBA the opportunity to precisely target those specific issues where adjudication is most error-prone and additional training is needed.
Important limits
m21-4:3.4 is primarily internal workflow guidance about availability of review results. It can help identify what VA was expected to document, but it does not by itself create a claimant deadline, a freestanding entitlement, or a guaranteed remedy. The source also states: The national quality reports are updated monthly. Non-rating accuracy is reported on a claim-based level; Claim-based reviews assess accuracy based on the entirety of the claim. If one BE element of the claim is incorrect, the claim is marked as incorrect.
Search terms when useful
Phrases that may help when searching your claim file or this library.
- Availability of Review Results
- m21-4:3.4
- Availability Review Results
- Recording Analysis Review Results
- This topic describes recording
- categories
- Decision Documentation Notification Categories
- issue-based claim-based rating reviews
Original VA guidance
The official VA text of this section
4. Recording and Analysis of Review Results
Introduction
This topic describes procedures for recording and analysis of review results, including
- availability of review results
- BE categories
- Decision Documentation / Notification Categories
- issue-based and claim-based rating reviews
- task-based and claim-based non-rating reviews
- claim-based accuracy, and
- issue-based accuracy.
Change Date
September 10, 2024
3.4.a. Availability of Review Results
The results of national reviews are maintained in QMS.
- National Quality reports are published via the VBA Intranet in twelve-month rolling cumulative, three-month rolling cumulative, quarterly, and monthly formats for non-rating claim-based and rating issue-based errors.
- Distribution of error reports are provided in twelve-month rolling cumulative as well as monthly and quarterly formats.
The national quality reports are updated monthly. Non-rating accuracy is reported on a claim-based level; rating accuracy is reported on an issue-based level. In accordance with standard statistical practice, VBA reports weighted accuracy results.
Note: RO performance ratings are generated during September using the most current available data. For STAR reports, the most current data available in September will generally be the twelve-month cumulative report for the period from August of the prior fiscal year through July of the current fiscal year. This represents the STAR performance year.
3.4.b. BE Categories
BE review categories include
- addressing all issues
- duty to assist (38 CFR 3.159) and other applicable regulations for complete development
- correct decisions
- correct evaluations
- correct effective dates, and
- correct payment rates.
Note: The BE accuracy rate is the official measure of claims processing accuracy.
3.4.c. Decision Documentation / Notification Categories
Decision documentation/notification categories include review of the decision and the notification sent to the claimant.
3.4.d. Issue and Claim Based Rating Reviews
Effective October 1, 2012, issue-based reviews are conducted in conjunction with the traditional compensation rating claim-based reviews.
An issue-based review and a claim-based review are conducted on every compensation rating claim submitted for national quality review.
3.4.e. T ask Based and Claim Based Non-Rating reviews
Effective July 1, 2017, task-based reviews are conducted in conjunction with the traditional compensation non-rating claim-based reviews.
A task-based review and a claim-based review are conducted on every compensation non-rating claim submitted for national quality review.
3.4. f. Claim Based Accuracy
Claim-based reviews assess accuracy based on the entirety of the claim. If one BE element of the claim is incorrect, the claim is marked as incorrect. Claim-based accuracy is calculated as the percentage of cases considered correct out of the total number of cases reviewed.
3.4. g. Issue Based Accuracy
Issue-based accuracy is measured by individually evaluated medical contentions within a rating-related compensation claim.
Each issue must go through the same claims process that represents a series of completed tasks, such as development, research, adjudication, and decision, that could result in a specific benefit for a Veteran or survivor. More importantly, issue-based accuracy provides VBA the opportunity to precisely target those specific issues where adjudication is most error-prone and additional training is needed. ROs are provided with the total number of issues reviewed, and the total number of issues in error, on every issue-based review.
Note: Issue-based accuracy is calculated as the percentage of issues considered correct based on the total number of issues reviewed for any review period.