Wednesday, June 8, 2016

The Supreme Court and the Disease Concept of Alcoholism


350z33 at English Wikipedia [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons

Has the U.S. Supreme Court ever been confronted with the issue of whether alcoholism is a disease?   Yes, as a matter of fact, in the 1988 case, Traynor v. Turnage, 485 U.S. 535 (1988).  But it punted.

In Traynor, two honorably discharged veterans, who suffered from years of alcohol addiction, failed to use all of their GI Bill educational assistance benefits within 10 years of their military service.  Federal law required veterans to use such benefits within that time frame, or forfeit the unused amount.  But the law allowed veterans to request an extension of the 10 year period if they were prevented from using their benefits by a physical or mental disorder which was not the result of their own willful misconduct.  The veterans applied to the Veterans' Administration (VA), claiming they were entitled to the extension on the ground that they were disabled by alcoholism during much of the 10 year period.

The VA denied the veterans' extension requests, because its regulations defined alcoholism as "willful misconduct."  Petitioners filed separate federal court actions - one in the Second Circuit and the other in the D.C. Circuit - seeking judicial review of the VA's decisions.

Procedural History

The procedural history is interesting because the Second Circuit held that veterans were not even entitled to judicial review of VA determinations made pursuant to the particular federal law. The VA denial was therefore upheld.  In contrast, the D.C. Circuit held that VA determinations were subject to judicial review, but nevertheless sided with the VA.  The court reasoned that the VA could reasonably conclude that alcoholism is a "willfully caused handicap" unless attributable to an underlying psychiatric disorder.

The Supreme Court first held that the question whether a VA regulation violates federal law is subject to judicial review, and went on to address the merits of the veterans' claims.

Decision on the Merits

The Court observed that since World War II, Congress had always imposed time limitations on the use of GI Bill educational benefits.  In 1977, Congress created an exception to the current 10-year delimiting period for veterans who were forced to delay their education because of a physical or mental disability, as long as that disability was not the result of their own willful misconduct.

Congress has long used the term "willful misconduct" in veterans' benefits statutes.  The term has been used to deny compensation for service-connected disabilities that are "the result of the veteran's own willful misconduct."  Interpreting these statutes, the VA has long promulgated regulations construing the term "willful misconduct" to include alcoholism not caused by an underlying psychiatric disorder.

Congress was presumed to know about the VA regulations at the time it enacted the 1977 legislation. The Court thus reasoned that if Congress had intended alcoholism not be deemed "willful misconduct," as it had been deemed for purposes of other veterans' benefits statutes, "Congress most certainly would have said so."

The Court did not believe VA regulations to be unreasonable, because a veteran who claims to have been disabled by alcoholism is entitled to an individualized assessment of whether his or her condition was the result of a mental illness, and not due to willful misconduct.

The American Medical Association (AMA) has classified alcoholism as a disease since 1957.  But that did not sway the Court.  The Court, quoting the D.C. Circuit, noted that "a substantial body of medical literature . . . contests the proposition that alcoholism is a disease, much less that it is a disease for which the victim bears no responsibility."

The Court noted:
Indeed, even among many who consider alcoholism a "disease" to which its victims are genetically predisposed, the consumption of alcohol is not regarded as wholly involuntary.  
Yet the Traynor decision should not be regarded as the complete repudiation of the disease concept of alcoholism.  The Court offered these closing remarks, possibly to assure the AMA, that it was remaining neutral.
This litigation does not require the Court to decide whether alcoholism is a disease whose course its victims cannot control. It is not our role to resolve this medical issue, on which the authorities remain sharply divided. Our task is to decide whether Congress intended . . .  to reject the position taken on the issue by the Veterans' Administration and by Congress itself only one year earlier. In our view, it is by no means clear that [the federal statute] and the characterization of . . . alcoholism as a willfully incurred disability are in irreconcilable conflict. If petitioners and their proponents continue to believe that this position is erroneous, their arguments are better presented to Congress than to the courts.
In our next post, we'll take a look at the dissenting opinion in Traynor.


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