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Systematic Technical Accuracy Review (star)


Jay
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Question

I called my VFW rep yesterday and was told my file was RANDOMLY pulled and sent to Tenessee for something called Systematic Technical Accuracy Review (STAR) which I was told takes about 60 days. The VFW rep told me very rarley are C-Files pulled when claims are still pending as is the case with my file.

I've done searches and am not finding much detailed information on this STAR revew. It mostly talks about it's purpose is for accuracy and consistency of claims of ROs in different regional centers. But what can the recommendations do to one's claims?

The reason for the concern:

I had a rating decision in June that was fairly favorable but did not totally hit the mark. Therefore, I put in a NOD for an early effective date and percentage increase. I learned that this NOD I put in for the recent June rating decsion was not part of my C-File that went to this STAR review (this NOD included a recent letter regarding a C&P and rating decision that I believe should help my BVA appeal contentions).

Any detailed advice on this STAR review thing especially with regards how it may or may not effect previous and current rating decisions, pending NODs, or the BVA appeal that I have open since 2005 (certified and docket number has been assigned).

Thanks

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  • HadIt.com Elder

The small quality control team that keeps an eye on everyone's claims is housed at the Nashville, TN VARO. They are the ones who are tasked with making every single rater follow the rules by randomly checking C-files/ratings for vets throughout the entire system. I wouldn't worry about this holding up your claim too much. This is a good thing for everyone. Especially for those of us that use the Nashville VARO, cause our decisions are usually really close to the mark as far as the regs go, because they know they can't get away with much.

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rentalguy1 First congrats on your position as a moderator. I think you'll be great. Was it helpful for you that you were in the same area as this QA team?

When they check a vets claim file do they start from the very beginning? Do they check for missed conditions that should have been rated or considered(implied or otherwise) for a disability rating, increase or early effective dates? Do they ever recommend reducing a previous ratings? Do they have the power to make these changes on the spot or recommend the original RO to fix any issues?

Just curious because some of my attempts to logically connect the dots to explain a nexus have been hard to explain and get across.

Thanks again for the reply

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  • HadIt.com Elder

I can't be 100% certain whether it helped to have them there or not. What I can say is that I had 11 claims working at one time, and it only took ten months to get a decision. The decision followed the regs to the letter, with one exception. I had a piece of evidence that was ignored. It was one line in a VAMR, but it was the only line that I had that made a nexus for GERD. I can see how it was missed in all the evidence, so I am confident that it will be awarded on appeal.

I am not sure what kind of authority they have, but I believe that they only look for problems and mistakes, and then report them back to the RO to fix. I could be wrong on that, though.

From the GAO web site:

Congress, the Department of Veterans Affairs, and veterans service organizations have all raised concerns about the accuracy of claims processing in the Veterans Benefits Administration (VBA). In 1998, VBA launched its systematic technical accuracy review (STAR) system to better measure the accuracy of claims processing. The system determines accuracy rates for (1) the nation as a whole, (2) each VBA service delivery network, and (3) each VBA regional office. GAO reported in 1999 that the accuracy rates for claims processing at regional offices was being determined by regional staff who themselves were involved in processing claims and who reported to managers responsible for claims processing. This arrangement did not meet either the government's internal control standard calling for the segregation of key duties or the performance audit standard calling for organizational independence for those who review and evaluate program performance. Congress subsequently required VBA to institute a quality assurance program that met government standards. VBA plans to modify the STAR system by October 1, 2001, to bring it into compliance with the standards on the segregation of duties and organizational independence. All STAR reviews will be done by staff of the Compensation and Pension Service who themselves do not process claims and do not report to managers responsible for claims processing. If implemented as planned, this change should bring the STAR system into compliance with government standards.

Link to GAO page.

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I received this from a friend who works claims at a VA office. I don't know if it is exactly the STAR program, but it is very close the way it sounds... and it doesn't seem to be very popular:

**********

We have been told that claims (rec'd by our R/O) are not to be rated until EVERYTHING

on the claim can be rated AT ONE TIME, as the "clock starts ticking" (on appeals,I presume) when and if the 1st. issue is decided. Our office is receiving BOATLOADS of brokered cases from other R/Os & we ARE allowed to rate & defer other R/Os cases, but we are instructed NOT to rate & defer our own R/O's cases.....(this must have something to do with the way the regional office's stats are presented)???

Each person at the R/O has 5 of their cases randomly taken up by numerous folks who do nothing but look at other people's work. I suggest that we should drop to 2 or 3 cases and have the majority of those folks quit doing surveys of the work of others AND START RATING THEIR OWN CASES. (The WATCHERS ARE WATCHING THE WATCHERS). OMB, as I understand it, laid down these rules, which may be OK for working with budgets, but NOT with putting veteran's lives on hold. If each R/O cut their Q/A staff by 1/2, boatloads of back-logged cases could start being rated.

***********

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  • HadIt.com Elder

If they could read the regs and apply them correctly, then there would be no need for all the QA teams.

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rentalguy1 and jrfrog

Thanks for your inputs. Seems the STAR thing is somewhat vague area. The reason I've brought this topic up is I am hoping in someway they would be able to help in showing the RO the nexus/relationship case I have had open since 2002. It also seems that you are going through the same sort of thing rentalgu1 with your ignored information. This 60 day review appear that it will also lengthen my claim. With your all your experience maybe you can help fill in the blanks.

In 2002 I filed for Bipolar II / Anxiety disorder / Panic Disorder (I was seeing a Private Psychologist who diagnosed PTSD. He recommended me to VA for med control where I was also diagnosed with Bipolar II and anxiety issues.

In 2003/ 2005/ 2007 I recieve pretty much the same De Novo Review/ SOC / and SSOC denials - no evidence that any of these conditions were caused or aggrivated in service.

In 2006 I put in for PTSD claim on aggravation due to a IMO Psych evaluation test performed by a Clinical/Forensic Psycologist. The result was Axis I Bipolar II, PTSD GAF 60 Preexisting PTSD more likely than not aggravated by service (PTSD was the focus of the treatment - meds were for biloar were done by another Psychiatrist).

In 2008 - a June C&P exam for the PTSD reported Preexisting PTSD with Bipolar II

Determination was that it was just as likely aggravated by service. That I had mood swings and concurrent diagnosis of Bipolar II, very anxious and panic attacks and that all systems are consistent with PTSD diagnosis(Axis I PTSD 50, Bipolar II 60). The rating decisions said prior to service I had Preexisting PTSD with evidence of mood swings, anxiey and panic attacks. The preexisting rating was shown to be 30% preexisting and current rating of 70% (PTSD with biploar II) for a combined total of 40% PTSD rating. (70%-30%). I have no service entry records that show anything regading the level of preexisting disability.

Late June 2007 I put in a NOD for a earlier effective date for the Bipolar II/ Anxiety/ Panic Disorder based on this new evidence from the C&P exam and the rating decision. However, I found that my C-File went out to Nashiville for the STAR report before the NOD made it to my C-File.

I am nervous that the PTSD C&P exam and rating decision (and my NOD description) won't be part of this NOD review. I was hoping that it would be together so the STAR reviewer would notice this nexus and be able to help the RO with a favorable rating decsion for an earlier effective date and to drop the 30% preexisting part for a rating of 70% right out (based on the regulation that says if the preexisting portion is unascertainable then any preexisting conditions will not be deducted on the final valuation).

What do you think? Do you I have a legitimate/plausable nexus/complaint? Will the STAR review have a copy of the latest C&P and rating decsion and see these discrepancies and be able to recommend or change the results? If they do then I have no reason to continue on to the BVA appeal I've been waiting for since 2005. I have asked for both a local DRO and traveling BVA hearing.

I know you may not know the answer to this but if you were the DRO or STAR review officer how might you see my chances?

Hope I haven't confused you with this lengthy post.

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