What this means
m21-4:7.4 explains availability of review results. In plain terms, the official guidance says the results of national reviews are maintained in the QMS. All accuracy reports within the database include PMC specific and national results. The reports are published and distributed as follows: It also addresses the BE accuracy rate is the official measure of claims processing accuracy and is the result used for performance measurement purposes
How this may help with a claim
Use m21-4:7.4 when organizing evidence or checking VA's handling of availability of review results. Compare your application, supporting records, and notice with this source-specific point: The results of national reviews are maintained in the QMS. All accuracy reports within the database include PMC specific and national results. The BE accuracy rate is the official measure of claims processing accuracy and is the result used for performance measurement purposes Save proof of submission and identify the exact condition, exception, or missing development step before requesting correction or choosing a review option.
What to review in your file
- Check the file against this official condition: The results of national reviews are maintained in the QMS. All accuracy reports within the database include PMC specific and national results. The reports are published and distributed as follows:
- Confirm that the record or notice addresses this source point: Claim-based reviews assess accuracy based on the entirety of the claim. If one BE element of the claim is not correct, the claim is marked as incorrect.
- Document how this stated step or exception applies: The BE accuracy rate is the official measure of claims processing accuracy and is the result used for performance measurement purposes
Important limits
m21-4:7.4 explains VA guidance for availability of review results; 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 results of national reviews are maintained in the QMS. All accuracy reports within the database include PMC specific and national results. Accuracy of these categories is assessed and reported but is not included for station quality performance.
Search terms when useful
Phrases that may help when searching your claim file or this library.
- Availability of Review Results
- m21-4:7.4
- Availability Review Results
- Recording Analysis Review Results
- categories
- decision documentation notification categories
- claim-based accuracy.
- 4.a. Availability Review Results
Original VA guidance
The official VA text of this section
4. Recording and Analysis of Review Results
Introduction
This topic contains information on procedures for recording and analysis review results including
- availability of review results
- BE categories
- decision documentation/notification categories, and
- claim-based accuracy.
Change Date
October 15, 2021
7. 4.a. Availability of Review Results
The results of national reviews are maintained in the QMS. All accuracy reports within the database include PMC specific and national results. The reports are published and distributed as follows:
- STAR accuracy reports are published via the VBA intranet in a 12-month rolling cumulative, 3-month rolling cumulative, quarterly, and monthly, and
- distribution of error reports are provided in 12-month rolling cumulative and quarterly formats.
Note: Station performance ratings are generated during September using the most current available data. For STAR reports, the most current data available in September will be the 12-month cumulative report for the period from October through September. This represents the performance year.
7.4.b. BE Categories
BE review categories include
- addressing all issues
- Duty to Assist (DTA) (38 CFR 3.159) and other applicable regulations for complete development, and
- correct
- decisions
- evaluations
- effective dates, and
- payment rates.
Note: The BE accuracy rate is the official measure of claims processing accuracy and is the result used for performance measurement purposes
7.4.c. Decision Documentation/ Notification Categories
Decision documentation/notification categories include review of the decision and the notification sent to the claimant.
Note: Accuracy of these categories is assessed and reported but is not included for station quality performance.
7.4.d. Claim-Based Accuracy
Claim-based reviews assess accuracy based on the entirety of the claim. If one BE element of the claim is not correct, 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.