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.
EP Review However, if a rating decision is necessary to complete action on the EP, that decision will also be subject to review. Compensation authorization EPs subject to national quality review are 130, 131, 132, 134, 136, 138, 139 – Dependency claims for living Veterans 290, 291, 292, 294, 296, 298 – Eligibility determinations, and 600, 601, 602, 603, 604, 605, 606, 609 – Predetermination notice. 3.03 Quality Review Structure Introduction This topic describes the quality review structure, including STAR checklists general guidelines for quality reviews grace period for STAR errors procedural deficiencies determining whether a case is correct or in error deselections reviewing all evidence associated with a claim clearly identifying and explaining errors appropriate citations cascade effect recording additional errors, and documentation of additional errors. Change Date March 4, 2016 a. STAR Checklists The STAR process requires a comprehensive review and analysis of all elements of processing associated with a specific claim or issue. STAR checklists are designed to facilitate consistent structured reviews. The Rating and Authorization checklists classify errors into three categories Benefit Entitlement Decision Documentation/Notification, and Administrative.
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 A2j. SMC – other A2k. Other Proper Development B1) Was 38 USC §5103 pre-decision “notice” provided and adequate? B1a. New and Material Verbiage B1b. Pension or SMP development incomplete B1c. Special issue development incomplete B1r. VCAA not sent B1s. “What the Evidence Must Show” attachment missing or incorrect B1t. Other B2) Does the record show VCAA compliant development to obtain all indicated evidence (including a VA exam, if required) prior to deciding the claim? B2a. Admin denial insufficient – rating decision needed B2b. Advisory opinion needed from Comp or Pension Service B2c. Appeals issue
B2d. Complete income information not obtained B2e. Dependency verification deficiency B2f. Insufficient VA examination/medical opinion B2g. IU development deficiency (i.e., 8940 needed before grant; employment history needed, etc.) B2h. Non-VA treatment records development deficiency B2i. SBP verification deficiency B2j. Service personnel records needed B2k. Service treatment records needed B2l. Social Security records development deficiency B2m. Special issue development incomplete B2bb. VA exam was needed B2cc. VA medical opinion was needed B2dd. VA treatment records not obtained B2ee. VCAA reply period not expired before denial B2ff. Other Grant or Deny C1) Was the grant or denial of all issues correct? C1a. Accrued benefits (warranted or not warranted) C1b. Hearing loss not shown under 38 CFR 3.385 C1c. Service connection not warranted for 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)
PLCP Identifies cases that are processed in an electronic environment DBQ – VA provider If the claimant submits a DBQ completed by a VA provider, then select this field and then identify the VA facility that completed the DBQ. This does not include DBQs completed by a VA provider at the request of a RO or AMC. DBQ – private provider If the claimant submits a DBQ completed by a private provider, then select this field Total number of issues reviewed (includes missed issues and missed inferred issues) Enumerate the number of issues reviewed as part of the STAR process, to include the Award document if such a document was required to promulgate the rating decision (e.g., no award document is required when the rating decision confirms and continues the evaluation of the SC disability; therefore even if the RO generates an award document, it would not be counted). Number of issues with BE errors Self-explanatory. Appendix B. STAR Authorization Quality Review Checklist Introduction This appendix includes the STAR Authorization Quality Review Checklist instructions and guidelines for authorization review, and authorization review elements. Change Date August 13, 2015 a. STAR Authorization Quality Review Checklist The following is a sample of the authorization checklist. Regional Office Number ____________ Claim Number______________ End Product _________________________ Veteran’s Name _______________ Authorization Checklist
3.103(b)(2), are provisions for due process associated with adverse actions. Additional instructions for implementation are found in M21-1, Part I, Chapter 2. Strict adherence to these procedures is necessary both from the customer’s perspective and the Government’s. I1) Was a predetermination notice sent? This notice is based upon a proposed, rather than final, action. Contemporaneous notice is not included. I2) Was the predetermination notice fully informative? All of the elements specified in M21-1, I.2.B.2 must be included in this notice. I3) Was the claimant given 60 days to respond before the due process period expired? Control is maintained under end product 600. A 60-day waiting period is required unless the claimant agrees to the proposed action, states that all evidence has been provided, or the reduction is deemed unnecessary prior to expiration of due process. ADMINISTRATIVE DECISIONS DENIALS J1) Admin – Grant or Denial – Was all applicable evidence discussed? Question J1 is self-explanatory. J2) Admin – Grant or Denial – Was the basis of each decision explained? Question J2 is self-explanatory. J3) Were required formal admin decisions completed and correct (apportionment, deemed valid marriage, character of discharge, etc.)? 38 CFR 3.450 through 3.461 contains the basic rules for apportionment decisions. The specific requirement for a formal apportionment decision, for both favorable and unfavorable decisions, is found in III.v.3 and III.v.8.B. NOTIFICATION 38 CFR 3.103 contains the basic rule. Claimants and their representatives are entitled to timely notice of any decision made by VA. This rule applies to both awards and disallowances. K1) Was notification sent and documented in the file? Notification may be placed in claims folder or in the electronic record(s). The appeal period does not begin until the claimant and representative are notified of the decision. K2) Was the notification correct? Correspondence is VA’s primary communication medium. Information must be complete and accurate. K3) Were appeal rights included? Notice of procedural and appellate rights is required following every decision.
K4) Was Power of Attorney indicated, correct, and notification properly documented? The Corporate record should be updated to include designation of the claimant’s representative so computer-generated notices are furnished to both. ADMINISTRATIVE APPROPRIATE SIGNATURE (INTERNAL CONTROL) The appropriate signature has been added for internal control purposes only. It is a means of checks and balances to eliminate potential fraud situations. L1) Was the appropriate second signature documented? This question typically relates to an administrative decision. L2) Were three signatures appropriately documented when required? This question typically relates to an administrative decision COMMENTS Identified in this section are discrepancies that would have otherwise been considered errors had the end product in question been under review. Comments do not count as errors under the end product under review. M1a) Errors not associated with end product under review? Use for errors that are not related to EP under review and do not fall under M1b) Development Errors not associated with end product under review Self-explanatory. M1c) Decision Errors not associated with end product under review Self-explanatory. M1d) Payment Errors not associate with end product under review Self-explanatory. M1e) Comment for all other actions not associated with end product under review Use for comments for both EPs under review and/or EPs not currently under review. M1f) Notification Errors not associated with end product under review Use for letter issues that are not part of the EP under review and corrective action is required. M2) Notification Errors – end product under review SPECIAL CASE IDENTIFICATION In some instances, cases may be processed by a regional office that does not have jurisdiction of a case, such as brokered cases. Identifying a case under this section will give the proper office credit for the case under review. N1) Brokered Case? The regional office that processed the brokered case must be selected in this field. N2) Pension Management Center Case? The proper Pension Management Center must be identified in this field.