Availability of Review Results

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
• issue-based accuracy
• task-based accuracy, and
• Strategic Oversight and Analysis Reviews (SOARs).

Change Date

December 21, 2023

3.B.4.a. Availability of Review Results

VBA maintains results of national reviews in QMS. All accuracy reports within the databases include DROC-specific and national results.

OAR QA publishes

• national quality reports 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, and
• distribution of error reports in twelve-month rolling cumulative as well as monthly and quarterly formats.

OAR QA updates the national quality reports monthly. OAR QA reports non-rating accuracy on a claim-based level, and rating accuracy on an issue-based level. In accordance with standard statistical practice, VBA reports weighted accuracy results.

Note: VBA generates DROC performance ratings during September using the most current available data. For OAR QA reports, the most current data available in September will generally be the twelve-month cumulative report for the period from September through August. This represents the performance year.

3.B.4.b. BE Categories

BE review categories include

• addressing all issues
• DTA (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 and is the result used for performance measurement purposes.

3.B.4.c. Decision Documentation/ Notification Categories

Decision Documentation/Notification categories include review of the decision and the notification sent to the claimant.

3.B.4.d. Issue-Based and Claim-Based Rating Reviews

OAR QA conducts issue-based reviews in conjunction with the traditional compensation and pension rating claim-based reviews.

OAR QA conducts an issue-based review and a claim-based review on every compensation and pension rating claim submitted for national quality review.

3.B.4.e. Task-Based and Claim Based Non-Rating Reviews

OAR QA conducts task-based reviews in conjunction with the traditional compensation and pension non-rating claim-based reviews.

OAR QA conducts a task-based review and a claim-based review on every compensation and pension non-rating claim submitted for national quality review.

3.B.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, OAR QA marks the claim as incorrect. OAR QA calculates claim-based accuracy as the percentage of cases considered correct out of the total number of cases reviewed.

3.B.4. g. Issue-Based Accuracy

OAR QA measures issue-based accuracy by individually evaluated medical conditions 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 the VA the opportunity to precisely target those medical issues where adjudication is most error-prone and DROCs need additional training. OAR QA provides DROCs with the total number of issues reviewed, and the total number of issues in error, on every issue-based review.

Note: OAR QA calculates issue-based accuracy as the percentage of issues considered correct based on the total number of issues reviewed for any review period.

3.B.4. h. Task-Based Accuracy

OAR QA measures task-based accuracy by the individual tasks executed within a non-rating compensation claim.

OAR QA independently assesses each task. Task-based accuracy provides the VA the opportunity to precisely target those adjudicative actions where adjudication is most error-prone and DROCs need additional training.

Note: OAR QA calculates national task-based accuracy as the percentage of tasks considered correct based on the total number of applicable tasks reviewed for any review period.

3.B.4. i. Strategic Oversight and Analysis Reviews (SOARs)

DROCs must review and address national errors and all problem quality areas in the next periodic Strategic Oversight and Analysis Review (SOAR) covering the quality of claims actions.

Reference: For more information about SOARs, see M21-5, Chapter 1, Section C.