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The examiner should
express their opinion as appropriate in
terms of "more likely than not" or "as
least as likely as not" or "not as least
as likely as not" where: More likely
than not equal the probability is greater
than 50 percent; as least as likely as
not equal the probability is equal to or
greater than 50 percent; and not as least
as likely as not equal the probability is
less than 50 percent
In making a claim for service connection, the veteran has the
burden of submitting evidence sufficient to justify a belief
by a fair and impartial individual that the claim is well
grounded. 38 U.S.C.A. § 5107(a) (West 1991 & Supp. 1998). A
well grounded claim is "a plausible claim, one which is
meritorious on its own or capable of substantiation." See
Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990).

Establishing a well grounded claim for service connection for
a particular disability requires more than an allegation that
the particular disability had its onset in service. It
requires evidence relevant to the requirements for service
connection and of sufficient weight to make the claim
plausible and capable of substantiation. See Tirpak v.
Derwinski, 2 Vet.App. 609, 610 (1992); Murphy v. Derwinski,
1 Vet.App. 78, 81 (1990). The kind of evidence needed to
make a claim well grounded depends upon the types of issues
presented by a claim. Grottveit v. Brown, 5 Vet.App. 91,
92-93 (1993). For some factual issues, competent lay
evidence may be sufficient. However, where the claim
involves issues of medical fact, such as medical causation or
medical diagnoses, competent medical evidence is required.
Id. at 93. Evidentiary assertions by the veteran must be
accepted as true for the purposes of determining whether a
claim is well grounded, except where the evidentiary
assertion is inherently incredible or is beyond the
competence of the person making the assertion. See King v.
Brown, 5 Vet.App. 19 (1993).

Service connection may be established for a current
disability in several ways, including on a "direct" basis.
38 U.S.C.A. §§ 1110, 1131 (West 1991 & Supp. 1998); 38 C.F.R.
§§ 3.303(a), 3.304 (1998). Direct service connection may be
established for a disability resulting from diseases or
injuries which are clearly present in service or for a
disease diagnosed after discharge from service, when all the
evidence, including that pertinent to service, establishes
that the disease was incurred in service. 38 C.F.R.
§ 3.303(a), (b), (d) (1998).

The three elements of a "well grounded" claim for direct
service connection are: (1) evidence of a current disability
as provided by a medical diagnosis; (2) evidence of
incurrence or aggravation of a disease or injury in service
as provided by either lay or medical evidence, as the
situation dictates; and, (3) a nexus, or link, between the
in-service disease or injury and the current disability as
provided by competent medical evidence. See Caluza v. Brown,
7 Vet.App. 498 (1995); see also 38 U.S.C.A. § 1110 (West 1991
& Supp. 1998); 38 C.F.R. § 3.303 (1998); Layno v. Brown,
6 Vet.App. 465, 470 (1994); Espiritu v. Derwinski, 2 Vet.App.
492, 494-95 (1992). To establish a well grounded claim, a
claimant must submit evidence relevant to all elements of the
claim or to all material facts involved in the claim. See
Caluza v. Brown, 7 Vet.App. at 506 (1995); see Gilbert v.
Derwinski, 1 Vet.App. 49, 52 (1990), quoting Black's Law
Dictionary, 881 (5th ed. 1979) (a material fact is one upon
which the outcome of litigation depends).

In addition, service connection may be granted for a
disability which is proximately due to or the result of a
service-connected disease or injury. 38 C.F.R. § 3.310(a).
The United States Court of Veterans Appeals (Court) has held
that where service connection is sought on a secondary basis,
service connection could be granted for a disability which
was not only proximately due to or the result of a service-
connected condition, but could also be granted where a
service-connected disability had aggravated a nonservice-
connected disability, with compensation being paid for the
amount of disability which exceeded "the degree of
disability existing prior to the aggravation." See Allen v.
Brown, 7 Vet.App. 439 (1995). The Court held, in part, that
"pursuant to § 1110 and § 3.310(a), when aggravation of a
veteran's nonservice-connected condition is proximately due
to or the result of a service-connected condition, such
veteran shall be compensated for the degree of disability
(but only that degree) over and above the degree of
disability existing prior to the aggravation." Id. at 448.

The evidence of record demonstrates that the veteran suffered
a low back injury while in service. Service connection is
currently in effect for the residuals of this injury with
degenerative disc disease of the lumbosacral spine with
radiculopathy. This disorder is currently rated as 40
percent disabling.

As stated above, the veteran currently alleges that he
incurred disorders of the cervical spine, the thoracic spine,
and the left knee while in service. In the alternative, the
Board interprets the veteran's appeal to also include claims
for service connection on a secondary basis for these
disorders.