For years, appealing disability benefit denials from the Department of Veterans Affairs on issues ranging from post-traumatic stress disorder and depression to hypertension and hearing loss has been a long, complex and confusing process.
Congress responded to this troubling problem with a new law, implemented by the VA in 2019, to streamline and expedite the broken appeals process. But legacy appeals—those still awaiting adjudication—numbered 268,309 within the Veterans Benefits Administration in February 2019.
This is where Mary Frances Matthews, an operations senior management and program analyst at the VA, stepped in.
As the agency was implementing the modernized process to decide disputed cases within 125 days, Matthews created a parallel nationwide system that led to a dramatic 87% decrease of the VBA legacy appeals backlog by February 2021. During this same two-year period, the VBA also received and processed an additional 257,000 new appeals under the legacy system. This resulted in thousands of veterans receiving much-needed benefits.
“Mary Frances personally reviewed the workload, analyzed the nationwide capacity and manually moved work throughout the system to ensure peak performance,” said Brianne Ogilvie, the executive director of the VBA’s Office of Administrative Review. “She uncovered problems that posed risks to success, expertly managed COVID-impacted appeals and developed strong relationships with field teams to resolve urgent issues.”
Michael Edsall, assistant director of the VBA’s Office of Administrative Review, said that in the old system, an original claim could take a year or more to adjudicate, while appeals could last three to six years and have real-life consequences. On average, about 10% to 20% of appeals are granted, mostly because of new evidence.
“We have a lot of folks with a lot of problems, veterans on the verge of homelessness or who are homeless. They may have very severe medical issues or just a general financial hardship,” Edsall said. “Many veterans really need this money to survive, especially when we’re talking about the pandemic, and for the last year, a lot of people were unable to work.”
Matthews inherited a system where the resources available to process claims through several stages of review varied from office to office, with some locations not having enough people for one stage and others having a surplus. “There were bottlenecks all over the place,” Ogilvie said.
The backbone of Matthews’ strategy was the development of a new work-flow system for the legacy appeals to distribute the caseload more efficiently across the country’s 56 field offices.
Matthews worked with data analysts to get reports on where employees were and where the appeals caseload was assigned, and then reshuffled the workload to make sure each team had the right ratio of people for the assigned caseload.
Once Matthews developed the system, her next challenge was bringing station leadership on board, said John Shriver, a VBA operations chief.
“The biggest obstacle was getting the stations to buy in to what we were doing—you’ve got 56 different regional offices, so you’re dealing with 56 different directors and 56 different service center managers,” Shriver said. “Appeals often got thrown on the backburner. Mary Frances went in there and changed everyone’s mindset.”
One beneficiary of Matthews’ allocation system who had been stalled in the appeals process received a retroactive grant of more than $16,000 in a matter of months for a service-related ankle disability, VA officials said. In another example, they said a veteran’s long delayed case was expedited because of Matthews’ new process, resulting in a $28,000 retroactive payment for a shoulder disability.
Edsall called Matthews a natural leader.
“I put her in charge of a team that was struggling,” Edsall said. “Within 30 days, they had team synergy and they were really producing.”
Matthews said that helping veterans is her prime motivator, whether working directly with clients as she did when she started out or in her more recent leadership roles.
“I’m here to help make sure that we in the VA are providing veterans with the benefits that they deserve,” she said. “My colleagues and I feel very passionate about treating veterans fairly.”