regular supervision and training mandatory or optional reviews and spot checks controls of various kinds including cost controls or formal control procedures such as the Systematic Technical Accuracy Review (STAR) program, and special focused quality improvement reviews. b. STAR STAR is the Veterans Benefits Administration’s (VBA) national program for measuring compensation claims processing accuracy. STAR includes review of work in two areas claims that usually require a rating decision, and claims that generally do not require a rating decision. Note: STAR results are generated for all of VBA’s regional offices (ROs) and are included in both the station’s and the RO Director’s Performance Dashboards. c. Quality Review and the VSC The quality review system is intended to assist managers in monitoring the level of service to claimants. This system requires that quality observations and reviews be performed on a continuing basis in all areas of Veterans Service Center (VSC) operations. Note: The quality review system does not require that evaluations encompass every work team within the VSC. Subchapter II. Systematic Technical Accuracy Review (STAR) Methodology 3.02 Quality Review Sampling Introduction This topic describes the quality review sampling procedures, including selection procedures annual sample sizes rating end product (EP) review, and authorization EP review.
Change Date August 13, 2015 a. STAR Rating Quality Review Checklist The following is a sample of the rating checklist. Claim Number Reviewer: End Product EP Cleared By: Review Type: Review Date: DOC Disp Date: Compensation: Pension: Both: N/A: New: Reopened: Increase: N/A: Rating Redesign: Hybrid Rating: Traditional Rating: SOC: SSOC: N/A: AMC: DES: FNOD: Name: Discharge Date: YES NO N/A BENEFIT ENTITLEMENT Address All Issues A1) Were all claimed issues addressed? A1a. Ancillary Benefit (SAD, SHA, DEA, Paragraphs 28-30, etc.) A1b. Competency A1c. IU A1d. Pension A1e. SMC or SMP – A/A A1f. SMC or SMP - HB A1g. SMC – other A1h. Service Connection A1i. Secondary service connection A1j. Increased evaluation A1k. Earlier effective date A1l. Other A2) Were all unclaimed subordinate and/or ancillary issues addressed? A2a. 38 CFR 3.324 (multiple SC disabilities) A2b. Competency A2c. DEA A2d. Hypertension A2e. IU A2f. Medical care under 38 USC 1702 A2g. Pension (including extraschedular under 3.321b) A2h. SMC or SMP – A/A A2i. SMC or SMP – HB
symptom or lab finding (i.e., pain, proteinuria, etc.) C1d. Service connection not warranted (general) C1e. Service connection warranted (general) C1f. Other C2) Was the percentage evaluation assigned correct (including combined eval.)? C2a. Convalescence (warranted or not warranted) C2b. Misapplication of 38 CFR 4.86, Exceptional Patterns of Hearing Impairment C2c. Misapplication of bilateral factor C2d. Pyramiding (same symptomatology used for multiple disabilities) C2e. Reduction (warranted, not warranted, or done prematurely or too late) C2f. Separate evaluations warranted for one SC disability (i.e., knee LOM and instability) C2g. Over-evaluation (general) C2h. Under-evaluation (general) C2i. Other Award Actions D1) Are all effective dates affecting payment correct? D1a. Day after discharge (effective date incorrectly granted from day following RAD; or not granting from day following RAD when entitlement was shown) D1b. Dependency adjustment D1c. Diabetes complication – incorrect effective date D1d. Increased disability – incorrect effective date based on increase factually shown or not shown from that date D1e. IU – criteria met or not met from an earlier date D1f. Informal date of claim – missed or misapplied D1g. Liberalizing legislation misapplied D1h. Pension (granted administratively or by rating decision) D1i. SMC or SMP change D1j. Incorrect effective date for all other situations (general) D1k. Nehmer guidelines not followed, earlier effective date warranted D1l. Nehmer guidelines not followed, later effective date warranted D1m. Other D2) Were all payment rates correct?
- Be free from apparent contradictory statements. F3) Were appeal rights included? Notice of procedural and appellate rights is required following every decision. This may be furnished by attachment of VA Form 4107 or equivalent language in the body of the notification. F4) Was the Power of Attorney indicated, correct, and notification properly documented? The master record should be updated to include designation of the claimant’s representative so that computer-generated notices are furnished to both. ADMINISTRATIVE APPROPRIATE SIGNATURE (Internal Controls) The appropriate signature has been added for internal control purposes only. It is a means of checks and balances to eliminate potential fraud situations. G1) Was appropriate second signature documented? Question G1 is self-explanatory. G2) Were third signatures appropriately documented when required? Question G2 is self-explanatory. G3) Was the end product selected for review over-developed? Question G3 self-explanatory and is used only for data gathering purposes. G4) Did unnecessary development delay a decision on any claim associated with the EP under review? Question G4 is self-explanatory and used only for data gathering purposes. EXAMINATION & MEDICAL OPINION REQUESTS A medical opinion may be required to reconcile diagnoses, determine the relationship between conditions, determine etiology or nexus to service-incurred disease or injury, or determine whether and to what extent service-connected disability has aggravated a nonservice-connected condition. Before requesting an opinion, review the claim and supporting evidence to ensure that minimum evidentiary requirements have been met. Always provide the claims folder for the examiner to review. Guidelines are provided in M21-1, I.1.C.3 and III.iv.3. H1) If a VA examination was requested was that examination necessary and if an opinion was requested was the opinion an appropriate medical (not legal) question? Question H1 is self-explanatory. It is not cascading to select “YES” for G3 and “NO” for H1. H2) Examination Requests – Were correct worksheets requested? The appropriate exam worksheet is to be selected for each specific claimed condition identified in the General Remarks section,
including appropriate use of General Medical exam. [NOTE: If a general medical exam was requested the request must be supported by the remarks or other information in the exam request (for example, recently discharged Veteran)]. H3) Examination Requests – Were issues (disabilities claimed) clearly identified? The specific condition (or conditions) is (are) to be identified in the General Remarks section for each exam requested. Identify the evidence to be reviewed by tabbing it in the claims folder; however, advise the examiner that the review is not limited to this evidence. In the request, indicate the source (provider or facility) of the evidence, the subject matter and the approximate dates covered. H4) Examination Requests – When necessary or requested by VAMC was the claims folder provided by the regional office? Question H4 is self-explanatory. The reviewer should also select “YES” if the claims folder was available in electronic format and the examiner stated that it was reviewed. H5) Medical Opinion Requests – If a medical opinion was requested, were pertinent issues clearly identified and appropriate question(s) clearly asked? Clearly state the nature of the opinion requested. Also, explain why the opinion is needed, if this would clarify the request. H6) Medical Opinion Requests – Was the claim folder made available to the medical center by the regional office? Question H6 is self-explanatory. The reviewer should also select “YES” if the claims folder was available in electronic format and the examiner stated that it was reviewed. EXPEDITED FAVORABLE DECISION I) When evidence was sufficient to grant partial benefits, were those benefits granted promptly, while developing other issues? Make an intermediate rating decision if the record contains sufficient evidence to grant any benefit, including service connection at a noncompensable level. Grant service connection for a disability with a noncompensable evaluation, if supported by the evidence, even though the issue of service connection or compensation for other disabilities or the issue of a higher evaluation must be deferred. COMMENTS Identified in this section are discrepancies that would have otherwise been considered as errors had the end product in question been under review. Comments do not count as errors under the end product under review. J1) Errors not associated with end product subject to review? The same principles that are outlined in A1 through D2 apply. J2) Disability Determination The same principles that are outlined in C1 and C2 apply.