What this means
m21-4:7.2 explains selection procedures. In plain terms, the official guidance says 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). These EPs are randomly sampled from those completed during the previous month. It also addresses the total monthly sample for each RO includes both rating and authorization EPs, allowing assessment of all essential claim adjudication actions.
How this may help with a claim
Use m21-4:7.2 to audit how VA handled selection procedures. Start with the decision date, the issue being reviewed, and the evidence VA was allowed to consider, then compare the record with this rule: 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). The total monthly sample for each RO includes both rating and authorization EPs, allowing assessment of all essential claim adjudication actions. Cite the exact document and page when raising a factual or procedural error, and use the review rights in the actual notice for any deadline.
What to review in your file
- Check the file against this official condition: PA&I uses a statistical formula that considers both historical accuracy and workload values when determining valid sample sizes for rating and authorization EPs at each station.
- Confirm that the record or notice addresses this source point: Authorization EPs are those that require development, review, and administrative decision or award action, but generally not a rating decision.
- Document how this stated step or exception applies: 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).
Important limits
m21-4:7.2 explains VA guidance for selection procedures; it does not guarantee an award or replace the statutes, regulations, binding decisions, and review instructions that control an individual claim. Conditions and exceptions still matter, including this source point: 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). Rating EPs are those associated with original, new, and reopened claims, or claims for increased evaluation.
Search terms when useful
Phrases that may help when searching your claim file or this library.
- Selection Procedures
- m21-4:7.2
- Selection
- Quality Review Sampling
- annual sample sizes
- rating product review
- authorization review.
- 7.2.a. Selection
Original VA guidance
The official VA text of this section
2. Quality Review Sampling
Introduction
This topic contains information on the quality review sampling procedures, including
- selection procedures
- annual sample sizes
- rating end product (EP) review, and
- authorization EP review.
Change Date
October 29, 2020
7.2.a. Selection Procedures
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). These EPs are randomly sampled from those completed during the previous month.
The total monthly sample for each RO includes both rating and authorization EPs, allowing assessment of all essential claim adjudication actions.
7.2.b. Annual Sample Size
PA&I uses a statistical formula that considers both historical accuracy and workload values when determining valid sample sizes for rating and authorization EPs at each station.
Notes:
- Annual sample sizes are determined based on an average of two fiscal years’ (FYs) 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 during each monthly period for every PMC to have a full sample at the end of the year.
7.2.c. Rating EP Review
Rating EPs are those associated with original, new, and reopened claims, or claims for increased evaluation. Review of an EP is not limited to rating actions, but rather assesses the accuracy of all adjudicative actions leading up to the completion of that EP.
PMC rating EPs subject to national quality reviews are
- 020 – Reopened Dependency and Indemnity Compensation (DIC) claim, special monthly DIC claim
- 030 – PMC Board Grant Rating
- 030 – PMC Higher-Level Review Rating
- 040 – PMC Board DTA Error – w/IMO
- 040 – PMC Board DTA Error
- 040 – PMC Board DTA Error Rating
- 040 – PMC HLR DTA Error – Rating
- 040 – PMC Supplemental Claim Rating
- 120 series – New claims for Veterans and Survivors Pension to include special monthly pension
- 140 series – Original DIC claim, and
- 180 series – Original Veterans Pension claim.
7.2.d. Authorization EP Review
Authorization 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.
PMC authorization EPs subject to national quality reviews are
- 030 – PMC Board Grant Non-Rating
- 030 – PMC Higher-Level Review Non-Rating
- 040 – PMC Board DTA Error Non-Rating
- 040 – HLR DTA Error – Non-Rating
- 040 – PMC Supplemental Claim Non-Rating
- 135 – Hospital reductions and resumptions
- 130 – Dependency claim for pension and DIC recipients
- 150 series – Income, estate, and election issues to include medical expense adjustments
- 160 series – Burial claim
- 163, 164, and 165 – Accrued claim
- 190 series – Original Survivors Pension claim
- 290 – Eligibility determinations, incarceration adjustments, month-of-death determinations and loan guaranty benefits for pension and survivor recipients
- 330 – Hospitalization report, and
- 600 – Predetermination notice.