VA also uses  STAR data to estimate improper compensation and pension benefit  payments. VA Has Implemented Procedures to Address Deficiencies Identified with the STAR Program, but Continues to Face Challenges in Improving Accuracy

Over the past decade, VBA has taken several actions to improve its STAR  program and to address deficiencies identified by both GAO and VA’s OIG. For example, in March 1999, we found that STAR review staff lacked  sufficient organizational independence because they were also responsible  for making claims decisions and reported to regional office managers  responsible for claims processing. In response to our findings, VBA took  steps to address this by utilizing reviewers who do not process claims and  who do not report to managers responsible for claims processing. More  recently, in February 2008, we found that STAR was not sampling enough  initial pension claims to ensure the accuracy of pension claims decisions. In a September 2008 report, we noted that VA lacked sufficient and  specific performance measures for assessing the accuracy of decisions on  BDD claims and recommended that VA consider options for separately  estimating the accuracy of such claims decisions. In its March 2009 report, VA’s OIG also identified several deficiencies in  the STAR program and recommended corrective actions. Further, the OIG  found that VBA did not have minimum training requirements for STAR  reviewers. As of March 2010, VBA had taken actions to respond to all of the OIG’s  recommendations related to STAR, including (1) implementing procedures  to follow up on cases not submitted by regional offices; (2) adding a  mechanism to the STAR database to remind reviewers of key decision  points; (3) requiring a second-level review of STAR reviewers’ work; and  (4) establishing a requirement that STAR reviewers receive 80 hours of  training per year. In fiscal year 2008, VBA more than doubled  the size of the quality assurance staff, allowing it to increase the scope of  quality assurance reviews. Although VBA has taken steps to address deficiencies in the STAR  program, the accuracy of its benefit entitlement decisions has not  improved. The accuracy rate was 86 percent in fiscal year 2008 and 84  percent in fiscal year 2009, well short of VBA’s fiscal year 2009 goal of 90  percent. VA Has Taken Actions to Strengthen Efforts to Monitor Consistency of Claims Decisions

VA has taken actions to address deficiencies identified with its consistency  review programs, but it is still too early to determine whether these  actions will be effective. In prior work, we reported that VBA did not  systematically assess the consistency of decision making for any specific  impairments included in veterans’ disability claims. Based on our recommendation, VBA’s  quality assurance staff began conducting studies to monitor the extent to  which veterans with similar disabilities receive consistent ratings across  regional offices and individual raters. VBA began these studies in fiscal  year 2008. The OIG recommended that VBA (1) develop an annual rating  consistency review schedule and complete all planned reviews as  scheduled; (2) dedicate sufficient staff to conduct consistency reviews in  order to complete planned workload and reviews; and (3) include inter- rater reliability reviews as a permanent component of its consistency  review program. Because VBA has  only recently implemented these initiatives, it is too early to determine  their impact on the consistency of claims decisions. Making  accurate, consistent, and timely disability decisions is not easy, but it is  important. Veterans’ Benefits: Improved Management Would Enhance VA’s Pension  Program. Veterans’ Benefits: Quality Assurance for Disability Claims Processing.
Why GAO Did This Study

For years, in addition to experiencing challenges in making disability claims decisions more quickly and reducing its claims backlog, the Department of Veterans Affairs (VA) has faced challenges in improving the accuracy and consistency of its decisions. GAO was asked to discuss issues surrounding VA's Systematic Technical Accuracy Review (STAR) program, a disability compensation and pension quality assurance program, and possible ways, if any, this program could be improved. This statement focuses on actions VA has taken; including those in response to past GAO recommendations, to (1) address identified weaknesses with STAR and (2) improve efforts to monitor the consistency of claims decisions. This statement is based on GAO's prior work, which examined several aspects of STAR, as well as VA's consistency review activities, and on updated information GAO obtained from VA on quality assurance issues that GAO and VA's Office of Inspector General (OIG) have identified. GAO also reviewed VA's OIG March 2009 report on STAR. GAO is not making any new recommendations.

What GAO Found

Over the past several years, GAO has identified several deficiencies with the Veterans Benefit Administration's (VBA) STAR program, and although VBA has taken actions to address these issues, it continues to face challenges in improving claims accuracy. For example, GAO found that STAR reviewers lacked organizational independence, a basic internal control principle. In response to our finding, VA began utilizing organizationally independent reviewers that do not make claims decisions. GAO also found that sample sizes for pension claims were insufficient to provide assurance about decision accuracy. In response to GAO's recommendation, in fiscal year 2009, VA began increasing the number of pension claims decisions it reviews annually at each of its offices that process pension decisions. VA has also taken a number of other steps to address weaknesses that VA's OIG found in the STAR program, including (1) establishing minimum annual training requirements for reviewers and (2) requiring additional supervisory review of STAR reviewers' work. Although it has made or has started making these improvements, VBA remains challenged to improve its decision accuracy for disability compensation decisions, and it has not met its stated accuracy goal of 90 percent. VBA's performance has remained about the same over the past several fiscal years. In addition, VA has taken steps to address deficiencies that GAO and the VA's OIG have identified with consistency reviews--assessments of the extent to which individual raters make consistent decisions on the same claims. For example, in prior work, GAO reported that VA did not conduct systematic studies of impairments that it had identified as having potentially inconsistent decisions. In response to GAO's recommendation, in fiscal year 2008, VBA's quality assurance staff began conducting studies to monitor the extent to which veterans with similar disabilities receive consistent ratings across regional offices and individual raters. However, last year, VA's OIG reported that VA had not followed through on its plans to conduct such reviews. In response to this and other OIG findings and recommendations, VA took a number of actions, including developing an annual consistency review schedule and hiring additional quality assurance staff. However, VBA has only recently begun these programs to improve consistency, and it is too early to assess the effectiveness of their actions.