15-08 298, 15-08 298

Veteran served on active duty (1966–1972); underwent cervical spine surgery on June 9, 2003 and a second surgery on October 18, 2003.
VA established service connection for residuals of the cervical surgery (effective June 9, 2003); later granted 100% for loss of use of both hands and SMC R-1 effective May 23, 2008.
Veteran contended loss of use of hands and need for aid and attendance began immediately after the June 9, 2003 surgery and sought earlier effective dates.
Record shows fluctuating symptoms in 2003: initial postoperative improvement, recurrence of numbness, and by October 31, 2003 VA notes documenting inability to perform basic ADLs (e.g., could not brush his teeth; could no longer feed himself by Nov 4, 2003).
Later medical and lay statements (2004–2015) describe progressive loss of hand function and dependence; private records characterize condition as quadriplegia by 2008.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Effective date for 100% rating for loss of use of both hands	Veteran: loss of use began immediately after June 9, 2003 surgery; effective date should be June 9, 2003	VA/Board: evidence shows functional loss became ascertainable later; current effective date was May 23, 2008 (contested)	Awarded effective date of October 31, 2003 (no sooner)
Effective date for SMC R-1 based on aid and attendance	Veteran: need for aid and attendance from June 9, 2003 onward	VA/Board: need for regular aid and attendance is ascertainable when ADL incapacity is documented; earlier dates not sufficiently supported	Awarded effective date of October 31, 2003 (no sooner)

Scott v. McDonald, 789 F.3d 1375 (Fed. Cir.) (VA notice and duty-to-assist standards)
Tucker v. West, 11 Vet. App. 369 (Vet. App.) (definition/analysis of loss of use)
Harper v. Brown, 10 Vet. App. 125 (Vet. App.) (effective date when increase is factually ascertainable)
Gilbert v. Derwinski, 1 Vet. App. 49 (Vet. App.) (benefit of the doubt rule for veterans claims)