What this means
m21-5:3.B.2 explains selection procedures. In plain terms, the official guidance says 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 OAR QA via the Quality Management System (QMS). It also addresses PA&I uses a statistical formula that considers both historical accuracy and workload values when determining valid rating and non-rating sample sizes at each DROC.
How this may help with a claim
Use m21-5:3.B.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: 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 OAR QA via the Quality Management System (QMS). PA&I uses a statistical formula that considers both historical accuracy and workload values when determining valid rating and non-rating sample sizes at each DROC. 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 rating and non-rating sample sizes at each DROC.
- Confirm that the record or notice addresses this source point: 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 OAR QA via the Quality Management System (QMS).
- Document how this stated step or exception applies: Compensation and pension rating EPs subject to national OAR QA review are:
Important limits
m21-5:3.B.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: 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 OAR QA via the Quality Management System (QMS). Compensation and pension rating EPs subject to national OAR QA review are:
Search terms when useful
Phrases that may help when searching your claim file or this library.
- Selection Procedures
- m21-5:3.B.2
- Selection
- Quality Review Sampling
- This topic describes quality
- annual sample sizes
- rating product review
- non-rating review.
Original VA guidance
The official VA text of this section
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
July 15, 2024
3.B.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 OAR QA via the Quality Management System (QMS). PA&I randomly samples these EPs from those completed during the previous month, which are identified using the transaction date.
The total monthly sample for each DROC includes both rating and non-rating EPs, allowing assessment of all essential claim adjudication actions.
3.B.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 at each DROC.
3.B.2.c. Rating EP Review
Rating EPs are those associated with original claims, supplemental claims, claims for increased evaluation, HLRs, pension, and appellate issues. They 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.
Compensation and pension rating EPs subject to national OAR QA review are:
- 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.B.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, rating decisions necessary to complete action on a non-rating EP are also subject to review.
Compensation and pension non-rating EPs subject to national OAR QA review are:
- 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