Court Opinion

ID: 9431252
Source: CourtListenerOpinion
Date Created: 2023-08-02 23:31:47.839874+00
Date Added: 2024-06-11T17:23:27.639599
License: Public Domain

Justice Blackmun,
with whom
Justice Brennan and Justice Marshall join, concurring in part and dissenting in part.
I join Parts I and II of the Court’s opinion, for I agree that, under § 504 of the Rehabilitation Act of 1973, 87 Stat. 394, as amended, 29 U. S. C. § 794, the “final and conclusive” language of 38 U. S. C. § 211(a) does not bar judicial review of petitioners’ claims. Similarly, I acknowledge the legality (a) of the 10-year delimiting period imposed by 38 U. S. C. § 1662(a) upon veterans’ educational assistance, and (b) of that statute’s alleviation of the delimiting period in cases of disability except where that disability is the result of a veteran’s “own willful misconduct.”
*553My dispute with the Court centers in its upholding of the regulation, 38 CFR § 3.301(c)(2) (1987), whereby the Veterans’ Administration (VA) presumes, irrebuttably, that primary alcoholism always is the result of the veteran’s “own willful misconduct.” This is the very kind of broad social generalization that § 504 of the Rehabilitation Act is intended to eliminate. The petitioners in these cases ask only that their situations be given individualized evaluation. Because I think this is what the Rehabilitation Act clearly requires, I dissent from the Court’s conclusion to the contrary.1
I
Petitioner Eugene Traynor began drinking when he was eight or nine years old. He drank with increasing frequency throughout his teenage years, and was suffering alcohol-related seizures by the time he was on active military duty in Vietnam. During the four years following his honorable discharge in 1969, Mr. Traynor was hospitalized repeatedly for alcoholism and related illnesses.
By the end of 1974, however, petitioner Traynor had conquered his drinking problem. He attended college part-time beginning in 1977, and continued working toward his degree until the 10-year period for using his veteran’s' educational benefits expired for him in 1979. Mr. Traynor applied for the extension of time available under 38 U. S. C. § 1662(a)(1) to one whose disability had prevented him from completing a program of education within the 10-year period. Because he was unable to establish that his alcoholism was due to an underlying psychiatric disorder, his condition was labeled “primary alcoholism.” Pursuant to the regulation cited above, Mr. Traynor was presumed to have brought his alcoholism upon himself through “willful misconduct.” The requested extension therefore was denied.
*554Petitioner James P. McKelvey also started drinking as a child. He was 13 when he began to develop the alcohol dependency that was common among members of his family. His drinking problem plagued him while he was in the Army, and he was hospitalized frequently during the nine years that followed his honorable discharge in 1966. Despite his disability, however, McKelvey managed, between hospital stays, to attend two educational institutions under the veterans’ educational-benefits program.
Mr. McKelvey took his last drink in 1975, only a year and a half before his 10-year delimiting period expired. Like Traynor, McKelvey sought an extension under 38 U. S. C. § 1662(a)(1) on the ground that his alcoholism had prevented him from using, within the period, the benefits to which he was entitled. And, like Traynor, McKelvey was denied the extension because his disability, primary alcoholism, was conclusively presumed to have been caused by his “own willful misconduct.” The VA’s regulation deprived each of these veterans of any opportunity to establish that, in his particular case, disabling alcoholism was not willfully incurred.
II
The VA’s reliance on its irrebuttable presumption that all primary alcoholism is attributable to willful misconduct cannot be squared with the mandate against discrimination contained in § 504 of the Rehabilitation Act. Just last year, in School Bd. of Nassau County v. Arline, 480 U. S. 273 (1987), this Court explained in no uncertain terms that § 504 bars the generic treatment of any group of individuals with handicaps based on archaic or simplistic stereotypes about attributes associated with their disabling conditions. Instead, § 504 requires an individualized assessment of each person’s qualifications, based on “reasoned and medically sound judgments.” Id., at 285. In sanctioning the VA’s irrebuttable presumption that any veteran suffering from primary aleo*555holism brought the ailment upon himself through willful misconduct, the Court ignores the lesson of Arline, and the clear dictate of the Rehabilitation Act.
In these cases, the Court is called upon, not to make its own medical judgments about the causes of alcoholism, but to interpret § 504. That statute sets forth a simple rule:
“No otherwise qualified individual with handicaps . . . shall, solely by reason of his handicap, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance or under any program or activity conducted by any Executive agency. . . .”2
It is beyond dispute that petitioners, as alcoholics, were handicapped individuals covered by the Act. See 43 Fed. Reg. 2137 (1978) (guidelines issued by Department of Health, Education, and Welfare (later the Department of Health and Human Services) reflecting the Attorney General’s specific conclusion, 43 Op. Atty. Gen. No. 12, p. 2 (1977), that an alcoholic is covered by the Act); see also Brief for Respondents 33. Nor is it disputed that § 504 of the Act prohibits federal agencies, such as the VA, from denying benefits to petitioners solely because they are alcoholics. See, e. g., 38 CFR §§ 18.403(j)(1) and (2)(i)(c) (1987).
In 38 U. S. C. § 1662(a)(1), Congress declared that one whose disability resulted from “willful misconduct” is not entitled to the benefit of the extension-of-time provision. As stated above, the VA, by its regulation, has established an irrebuttable presumption that primary alcoholism is the result of willful misconduct. This presumption appears to be a clear violation of § 504’s mandate requiring individualized *556assessment of each claimant’s qualifications. Arline, 480 U. S., at 287-289.
Respondents argue, however, that a case-by-case assessment of whether a claimant’s alcoholism was the result of willful misconduct is not necessary for two reasons. First, respondents contend that Congress, in enacting the 1977 amendment (the extension-of-time provision, see 91 Stat. 1439) to § 1662(a), mandated a conclusive presumption that primary alcoholism is caused by willful misconduct. Second, respondents contend that the VA’s determination that primary alcoholism always is due to willful misconduct is reasonable, and that therefore the presumption is not based on the kind of stereotyping that §504 forbids. The Court today finds each of these arguments persuasive. In my view, each patently is without merit.
Ill
The Court explains:
“As we see it, §504 does not demand inquiry into whether factors other than mental illness rendered an individual veteran’s drinking so entirely beyond his control as to negate any degree of ‘willfulness’ where Congress and the Veterans’ Administration have reasonably determined for purposes of the veterans’ benefits statutes that no such factors exist.” Ante, at 551.
As I see it, § 504 demands precisely the inquiry the Court says is unnecessary. While Congress certainly has the authority to determine that primary alcoholism always should t be attributed to willful misconduct, I find no support whatever for the Court’s conclusion that Congress made that determination when it amended § 1662(a) in 1977.
The Court is correct, of course, see ante, at 546, when it says that we must assume that Congress intended the term “willful misconduct” in § 1662(a)(1) to have the same meaning it had been given in other veterans’ benefits statutes. Indeed, the legislative history indicates that Congress did *557“inten[d] that the same standards be applied as are utilized in determining eligibility for other VA programs under title 38.” S. Rep. No. 95-468, pp. 69-70 (1977). If §504 had not been amended one year later to cover specifically all executive agency programs, including the VA’s benefits programs, see Pub. L. 95-602, §§ 119, 122(d)(2), 92 Stat. 2982, 2987, 29 U. S. C. § 794, there would be little reason to question the application of the VA’s interpretation of the willful-misconduct regulation to § 1662(a)(1).
But the Court goes further and finds that Congress’ reference to the VA’s willful-misconduct regulation in amending § 1662(a) is a congressional adoption of the VA’s rule. The Court transforms Congress’ uncontroversial statement that the willful-misconduct regulation should be given the same meaning throughout the statutory scheme into a “specific] determination]” by Congress that primary alcoholics are presumed to have engaged in willful misconduct. See ante, at 551, n. 11; see also ante, at 547 (Congress’ “1977 determination that primary alcoholism is not the sort of disability that warrants an exemption”); ante, at 548 (Congress had “‘narrow, precise, and specific’” intent to exclude primary alcoholics in enacting § 1662(a)(1)); ante, at 551 (“original congressional intent [in amending § 1662(a)] that primary alcoholics not be excused from the 10-year delimiting period”). This magical transformation is the linchpin in the Court’s analysis, for unless Congress itself actually took a position in 1977 endorsing the association of primary alcoholism with willful misconduct, the subsequent amendment of §504 in 1978 to include benefit programs like the VA’s would simply be read to impose new constraints on the VA’s treatment of alcoholics. There is nothing whatever that is inconsistent about Congress’ willingness, in 1977, to allow the VA to apply its own rules in determining which alcoholic veterans were entitled to benefits, and its decision, one year later, to require such determinations to comply with the antidiscrimination provisions of § 504 then being amended.
*558In order to escape § 504’s requirements, the majority must conclude that in 1977 Congress defined a primary alcoholic as not “otherwise qualified,” within the meaning of § 504, for the extension of time available under § 1662(a)(1). The language of § 1662(a)(1) itself merely establishes that a willfully incurred disability, as a general matter, does not entitle a veteran to the extension of time. And the Senate Report, upon which the Court exclusively relies, makes only passing reference to the relevant regulations — regulations which encompass the VA’s entire policy on the applicability of the willful-misconduct provisions, not just the application of that term to alcoholism. Finally, even those portions of the regulations expressly addressed to alcoholism do not state that primary alcoholism is to be equated with willful misconduct. That interpretation is derived from a 1964 Administrator’s Decision, which itself discusses the VA’s irrebuttable presumption only briefly. Administrator’s Decision, Veterans’ Administration No. 988, Interpretation of the Term “Willful Misconduct” as Related to the Residuals of Chronic Alcoholism 1 (1964).3 *559See 37 Fed. Reg. 20335, 20336 (1972) (proposing regulation and announcing that it was intended to incorporate principles of the 1964 administrative issue).
Surely something more than two sentences quoted from a Senate Report should be required before we interpret general statutory language to conflict with the most natural reading of subsequent specific legislation. It is only the Court’s strained reading of § 1662(a)(1) to embrace a congressional “determination that primary alcoholism is not the sort of disability that warrants an exemption,” ante, at 547, that leads the Court to reject as a disfavored “implicit repeal” § 504’s requirement that qualifications for the exemption be determined on a case-by-case basis. The “ ‘basic principle of statutory construction that a statute dealing with a narrow, precise, and specific subject is not submerged by a later enacted statute covering a more generalized spectrum,’” ante, at 547-548, has no application here, where the earlier enactment is not narrowly or specifically addressed to the matter treated generally in the subsequent enactment: federal agencies’ treatment of alcoholics. I have been no more successful than the VA or the Court in turning up evidence that Con*560gress expressly considered, or intended, in Amending § 1662 (a), to adopt legislatively the VA’s presumption that primary alcoholism always is attributable to willful misconduct. I therefore see no reason to defer to the VA’s rule in interpreting a subsequent and entirely separate congressional enactment that the VA has not been empowered to administrate.
IV
I am reluctant to conclude that anything short of a congressional determination linking all primary alcoholism to willful misconduct could justify the VA’s substitution of its generic rule for the individualized assessment generally required under § 504. It is conceivable that an agency legitimately could eschew individualized assessments of disabled individuals’ qualifications if it were evident, as a matter of medical fact, that a particular disqualifying characteristic always is associated with a particular disability.4 But it is not at all evident that an absolute correlation exists between the condition of primary alcoholism and the disqualifying factor of willful misconduct, as defined by the VA. Nor has the VA successfully demonstrated that such an absolute correlation is medically justified. The VA suggests that it is enough that “although the policy may not produce in an individual case the same conclusion another arbiter might reach, the VA policy provides a reasonable and workable accommodation of modern medico-psychological evidence.” Brief for Respondents 35 (emphasis added). This position is unsatisfactory for several reasons.
*561A
The VA seems to suggest that generalizations about attributes associated with individuals suffering from a particular disability can be relied upon to assess those individuals’ qualifications, as long as the generalizations are shown to be reasonable. But reliance on generalizations, even “reasonable” ones, is clearly prohibited under Arline. In that case, the Court ruled that §504 prevented the Nassau County School Board from generalizing about the contagiousness of tuberculosis. 480 U. S., at 281-286. Acknowledging that in some cases contagiousness would justify altering or perhaps terminating a tuberculosis sufferer’s employment in order to avoid infecting others, id., at 287, n. 16, the Court nevertheless found impermissible a generalization built on that less-than-perfect correlation between disability and qualification. The Court explained:
“The fact that some persons who have contagious diseases may pose a serious health threat to others under certain circumstances does not justify excluding from the coverage of the Act all persons with actual or perceived contagious diseases. Such exclusion would mean that those accused of being contagious would never have the opportunity to have their condition evaluated in light of medical evidence and a determination made as to whether they were ‘otherwise qualified.’ Rather, they would be vulnerable to discrimination on the basis of mythology — precisely the type of injury Congress sought to prevent.” Id., at 285 (emphasis in original).
The myth to which the Court was referring was not that some tuberculosis sufferers were contagious, but that they all were. The parallel myth in the present cases, of course, is that all primary alcoholics became disabled as a result of their own willful misconduct. Just as § 504 entitles each person suffering from tuberculosis to an individualized determination, based on sound medical evidence, as to whether *562that person is contagious and therefore not “otherwise qualified” for a job, 29 U. S. C. § 794, the statute entitles each alcoholic veteran to an individualized determination, based on the medical evidence in his own case, of the causes of his disability. If this individualized assessment leads the adjudicator to conclude that the particular veteran’s alcoholism was brought on by willful misconduct, that veteran will have been adjudicated to be not “otherwise qualified” to collect the education benefits. But only after this individualized inquiry has been conducted, can the VA deprive him of benefits available to all whose disabilities were not caused by willful misconduct.
B
The VA’s attempt to justify its reliance upon the irrebuttable presumption that primary alcoholism is caused by willful misconduct is further undermined by the meagerness of the medical support it summons. Nothing in the record suggests that the VA based its continuing reliance on the presumption, after § 504 was amended, on any factual findings of the kind found to be required in Arline. And its post hoc rationalization of that reliance in this litigation consists of a hodgepodge of medical conclusions, some of only marginal relevance. For example, the VA relies upon the comments of a number of “medical writers” who note that “volition plays a significant role” in the treatment of alcoholism. See Brief for Respondents 43; see id., at 45-46, and nn. 32 and 33, citing, among others, G. Vaillant, The Natural History of Alcoholism 299 (1983), and S. Zimberg, The Clinical Management of Alcoholism 67-69, 118 (1982). While cure and cause are likely to be somewhat related, the fact that alcoholism is “highly treatable, but . . . will require great responsibility from the patient,” G. Vaillant, supra, at 299, provides little assistance in assessing whether the original onset of the disability can always be ascribed to willful misconduct.
In contrast, ample evidence supports petitioners’ contrary contention that the degree of willfulness associated with the *563onset of alcoholism varies from case to case. Recent medical research indicates that the causes of primary alcoholism5 are varied and complex, only some of which conceivably could be attributed to a veteran’s will.6 Indeed, even the VA acknowledges that “alcoholism is not a unitary condition [but rather] has multiple forms and ranges of severity.” Brief for Respondents 34, and nn. 21, 22, citing, among others, Bohman, Sigvardsson, & Cloninger, Maternal Inheritance of Alcohol Abuse: Cross-Fostering Analysis of Adopted Women, 38 Archives Gen. Psychiatry 965, 968 (1981) (describing genetically different types of alcoholism, each producing a different form of the condition); Cloninger, Bohman, & Sigvardsson, Inheritance of Alcohol Abuse: Cross-Fostering Analysis of Adopted Men, 38 Archives Gen. Psychiatry 861, 867 (1981) (identifying two types of alcohol abuse with different genetic and environmental causes); G. Vaillant, supra, at 17 (“[A]lcohol abuse reflects a multidetermined continuum of drinking behaviors *564whose determinants are differently weighted for different people and include culture, habits, social mores, and genes”). A sensitivity to this case-to-case variation is precisely what § 504 requires of employers and federal agencies in their assessments of the qualifications for employment or benefits of an individual with handicaps. As the medical community’s understanding of the causes of alcoholism continues to develop, § 504 requires the VA to take these new developments into account in making “sound medical judgments” about the source of a particular veteran’s alcoholism.7 Presumably, evidence concerning the circumstances surrounding a veteran’s development of alcohol dependence — including his age, home environment, and psychological health8 — always will be relevant to this assessment.
C
Finally, in asserting that its automatic association of primary alcoholism with willful misconduct is supported by medical evidence, the VA adopts, perhaps for purposes of this litigation alone, a definition of willful misconduct which is inconsistent with the definition articulated in the VA’s own regulations and practices. According to the VA, primary alcoholism is appropriately attributed to willful misconduct because medical evidence suggests that “many alcoholics are not completely helpless,” in controlling their disability. Brief for Respondents 47 (emphasis added). But a “not completely helpless” test is not the standard the VA has estab*565lished for determining whether other disabilities are incurred willfully.
The VA defines willful misconduct as “an act involving conscious wrongdoing or known prohibited action,” 38 CFR § 3. l(n) (1987), and “the intentional doing of something either with the knowledge that it is likely to result in serious injury or with a wanton and reckless disregard of its probable consequences.” VA Manual M21-1, change 239, subch. I, § 14.04a (Aug. 21, 1979).9 This definition of willful misconduct is a far cry from a “not completely helpless” standard. While some primary alcoholics may well owe their disability to willful misconduct, as delineated by the regulation, the VA has failed to demonstrate that all primary alcoholics had any awareness that their initial drinking was likely to result in serious injury. Nor, in many cases, would it be appropriate to describe one’s gradual development of alcohol dependency as evidence of “wanton and reckless disregard of [drinking’s] probable consequences.” Indeed, I wonder how one meaningfully can ascribe such intent and appreciation of long-range consequences to a 9- or 13-year-old boy who follows the lead of his adult role models in taking his first drinks.10
The awkwardness of attributing all primary alcoholism to willful misconduct is made apparent in the Administrator’s Decision No. 988, which elaborates on the meaning of the term in the context of explaining why the VA does not bar recovery for those suffering organic secondary effects of the continued use of alcohol:
*566“[The] development of the secondary condition does not meet the definition of intentional wrongdoing with knowledge or wanton disregard of its probable consequences. Secondary results are not the usual and probable effects of drinking alcohol as a beverage. By the time there is sufficient awareness of any probable deleterious consequences, the process has developed to a point where it is irreversible without professional help. At such time, the person by himself, may lack the capacity to avoid the continued use of alcohol. While it is proper to hold a person responsible for the direct and immediate results of indulgence in alcohol, it cannot be reasonably said that he expects and wills the disease and disabilities which sometimes appear as secondary effects.” Decision No. 988, p. 2 (1964) (emphasis in original).
All of this surely can be said of some primary alcoholics, whose drinking begins innocently enough and who feel only much later the effects of a dependency so disabling that it requires repeated hospitalization.
Individuals suffering from a wide range of disabilities, including heart and lung disease and diabetes, usually bear some responsibility for their conditions. And the conduct that can lead to this array of disabilities, particularly dietary and smoking habits, is certainly no less voluntary than the consumption of alcohol. Nevertheless, the VA has expressed an unwillingness to extend the definition of willful misconduct to all voluntary conduct having some relation to the development of a disability. In justifying the exclusion of secondary organic effects of alcoholism, such as cirrhosis of the liver, from the reach of the willful-misconduct presumption, the VA has explained:
“[Historically, the question of willful misconduct has never been raised in other related situations where personal habits or neglect are possible factors in the incurrence of disability. For example, the harmful effects of tobacco smoking on circulation and respiration were *567known long before tobacco was incriminated as a causative factor in the high incidence of cancer, emphysema and heart disease. Yet smoking has not been considered misconduct. It is unreasonable and illogical to apply one set of rules with respect to alcohol and a different one in a situation closely analogous.” Ibid.
In deferring to the VA’s “reasonable” determination that all primary alcoholism is attributable to willful misconduct, the Court obscures the meaning of “willful misconduct” in a similar fashion. The Court discusses the propriety of denying benefits to those who “bear some responsibility for their disabilities,” and suggests that the attribution of all primary alcoholism to willful misconduct is justified because “the consumption of alcohol is not regarded as wholly involuntary.” Ante, at 549, 550. The degree of personal responsibility for their disability attributed to alcoholics by the VA in its brief and echoed by the Court in its opinion is clearly not of the magnitude contemplated by the VA’s general definition of willful misconduct.
V
Section 504 guarantees Eugene Traynor and James P. Mc-Kelvey federal benefits absent a demonstration that they, as individuals, fail to satisfy the legitimate qualifications Congress has imposed upon receipt of those benefits. The VA has failed to demonstrate that any legislative or medical determinations justify its conclusive presumption that Mr. Traynor’s and Mr. McKelvey’s alcoholism was incurred willfully. Both cases therefore should be remanded to the VA for individualized determinations, based on “sound medical judgments” whether these men are “otherwise qualified” to receive veterans’ educational benefits beyond the 10-year period.
I dissent.

 It perhaps is worth noting that, despite much comment in the popular press, these cases are not concerned with whether alcoholism, simplistieally, is or is not a “disease.”

 Section 103(d)(2)(B) of the Rehabilitation Act Amendments of 1986, 100 Stat. 1810, struck the words “handicapped individual” wherever they appeared in the 1973 Act and replaced them with the words “individual with handicaps.” See H. R. Rep. No. 99-571, p. 17 (1986). Section 504, as quoted in the text above, embraces the change effected by this 1986 amendment.

 The regulation provides:
“If, in the drinking of a beverage to enjoy its intoxicating effects, intoxication results proximately and immediately in disability or death, the disability or death will be considered the result of the person’s willful misconduct. Organic diseases and disabilities which are a secondary result of the chronic use of alcohol as a beverage, whether out of compulsion or otherwise, will not be considered of willful misconduct origin.” 38 CFR § 3.301(c)(2) (1987).
On its face, the regulation does not appear to address the condition of alcoholism itself, despite the fact that the paragraph of the regulation, of which the above-quoted material is a part, bears the title “Alcoholism.” The condition of alcohol dependency is neither an immediate effect of drinking, nor a secondary organic disability resulting from the chronic use of alcohol. Alcoholism seems to fall between the two categories set out in the regulation; it is the condition of being a chronic alcohol user.
The Administrator’s Decision from which the VA’s irrebuttable presumption is derived focuses on this same distinction: “The proximate and immediate effects consisting of disabling injuries or death resulting from a state of intoxication” are to be deemed willful misconduct, but the “remote, *559organic secondary effects of the continued use of alcohol resulting in impairment of body organs or systems leading to disability or death” are not to be so deemed. Administrator’s Decision, No. 988, p. 1. The Decision, however, also includes two sentences from which the VA derives its current interpretation of the willful-misconduct regulation:
“In misconduct determinations, however, with respect to mental disorders where the use of alcohol as a beverage has been involved, a distinction has heretofore been recognized between alcoholism as a primary condition (or as secondary to an underlying personality disorder), and alcoholism as secondary to and a manifestation of an acquired psychiatric disorder. If the latter condition is found the resulting disability or death is not to be considered as willful misconduct.” Ibid.-
While the VA’s interpretation of its own regulation and its antecedents would have been entitled to deference, see United States v. Larionoff, 431 U. S. 864, 872 (1977), Congress cannot be presumed to have codified this less-than-apparent interpretation by a mere reference to the relevant regulations.

 For example, a blind person, by definition, cannot see. While the Rehabilitation Act does not expressly recognize the absolute correlation between the qualification of seeing and the condition of blindness, it seems appropriate for an employer to rely on that absolute correlation in making certain hiring decisions. Presumably, an employer subject to § 504 could refuse to hire blind individuals for jobs clearly requiring sighted employees without first conducting an individualized assessment of each blind applicant’s qualifications.

 The American Medical Association and American Psychiatric Association (AMA/APA) and the National Council on Alcoholism, Inc. (NCA), emphasize in their respective amicus briefs that the primary/secondary distinction is a crude one. A diagnosis of alcoholism as primary or secondary may depend as much on the nature of the facility in which the diagnosis is made as it does on the alcoholic’s true clinical history. See Brief for NCA as Amicus Curiae 18-19, n. 9. The primary/secondary distinction is particularly difficult to apply to an alcoholic who, like petitioners, began drinking as a child before underlying psychiatric disorders could be diagnosed. See Brief for AMA/APA as Amici Curiae 7. AMA/APA also emphasizes that the distinction between the two kinds of alcoholism was developed, and is properly used, only for treatment purposes and reveals little about the degree of willfulness involved in the onset of the alcoholism. Id., at 5.

 Notable among the studies are those that suggest that heredity plays a significant role in the development of primary, but not secondary, alcoholism. See, e. g., Schuckit, Genetic Aspects of Alcoholism, 15 Annals Emergency Medicine 991, 992 (1986). Some evidence suggests that the genetic predisposition to alcoholism can be attributed to a biochemical abnormality that prevents proper metabolism of alcohol. See App. 44 (affidavit of Dr. Anne Geller). Prom this it would appear that there may be a more purely physiological explanation for the onset of some cases of primary alcoholism than there is for most cases of secondary alcoholism.

 In light of this Court’s emphasis in School Bd. of Nassau County v. Arline, 480 U. S. 273 (1987), on the importance of basing assessments of a person’s qualifications on sound medical evidence, it is difficult to understand the VA’s suggestion that “citations to the medical literature circa 1987” are not of great relevance to an analysis of § 504’s application. See Brief for Respondents 26.

 AMA/APA notes that there is often a “psychological component in the development of alcoholism” which may not “rise to the level of psychiatric disorders.” Brief for AMA/APA as Amici Curiae 6.

 Outside the alcoholism context, the Board of Veterans Appeals has found willful misconduct when, for example, a veteran “placed [a] gun to his head and pulled the trigger,” No. 86-22-350 (Mar. 23, 1987); or intentionally put his arm through window glass, No. 85-31-331 (Feb. 14, 1986); or attempted to ride his motorcycle on one wheel, No. 84-33-060 (May 13, 1985); or engaged in an altercation, No. 81-10-510 (June 12,1981); or drove about 100 miles per hour in a 25-mile-per-hour zone on a wet road at dusk, No. 80-31-502 (June 5, 1981).

 That puzzle, of course, would have to be worked out by the VA when considering petitioners’ claims on remand.