Medical Questions and Your Green Card: Get Clear Answers Before You Act

You’re preparing a green card application, or a relative just received a medical result you don’t understand. A medical condition disqualifies you from a green card only when it falls into a category that federal law names.

The USCIS Policy Manual lists these health-related conditions: a communicable disease of public health significance under HHS regulation; a failure to present documentation of having received vaccinations against vaccine-preventable diseases; a present or past physical or mental disorder with associated harmful behavior, or harmful behavior that is likely to recur; and drug abuse or addiction. This guide explains each one in plain terms, shows where the medical exam fits, and describes what usually happens after a finding.

Short answer: which medical conditions can bar a green card

A medical condition bars a green card when it is a Class A condition. Federal law lists the medical grounds of inadmissibility in 8 U.S.C. § 1182. USCIS explains how those grounds apply in its medical examination guidance. Under that guidance, a Class A condition makes an applicant inadmissible and ineligible for a visa or adjustment of status.

The Class A categories are:

• A communicable disease of public health significance
• A failure to show documentation of required vaccinations. This Class A condition only applies to aliens who seek admission as immigrants or who seek adjustment of status to one lawfully admitted for permanent residence, and an adopted child under 10 is not deemed to have it if the conditions in 42 CFR 34.2(d)(2) are met.
• A present or past physical or mental disorder with associated harmful behavior, or harmful behavior likely to recur
• Drug abuse or addiction

Having a medical condition is not the same as being inadmissible. A Class B condition is a health condition that is serious in degree or permanent in nature. If a civil surgeon records only a Class B condition, the applicant is never inadmissible on health grounds, according to USCIS guidance on the inadmissibility determination. For the wider process, read our adjustment of status guide.

How the medical exam (Form I-693) fits into adjustment

An applicant for adjustment of status must be examined by a designated physician when a medical examination is required, though by statute a U.S. Public Health Service medical officer may also conduct the examination; most examinations are done by a designated civil surgeon. Under 8 C.F.R. § 245.5, the report of the applicant’s mental and physical condition goes into the record. Under 8 C.F.R. § 245.5, an applicant for adjustment of status shall be required to have a medical examination by a designated civil surgeon, whose report setting forth the findings of the mental and physical condition of the applicant, including compliance with section 212(a)(1)(A)(ii) of the Act, shall be incorporated into the record. A medical examination shall not be required of an applicant who entered the United States as a nonimmigrant spouse, fianceé, or fianceeé of a United States citizen, or as the child of such an alien as defined in section 101(a)(15)(K) of the Act and § 214.2(k) of this chapter, if the applicant was medically examined prior to, and as a condition of, the issuance of the nonimmigrant visa, provided that the medical examination must have occurred not more than 1 year prior the date of application for adjustment of status (8 C.F.R. § 245.5).

Civil surgeons examine applicants inside the United States. Panel physicians do the same work abroad, for immigrant visa and refugee applicants. The civil surgeon owns the medical findings. USCIS officers are told not to alter sections the civil surgeon must complete, per USCIS guidance on vaccination records.

Bring the records you have, such as past vaccine or treatment records. The civil surgeon reviews what you bring, so an accurate history helps the exam go smoothly. If you have questions about the process, Adriana Gomez, the responsible lawyer for this page, can explain how it fits your situation.

Communicable diseases of public health significance

A communicable disease of public health significance is a Class A condition. The Department of Health and Human Services designates the list, and USCIS guidance on communicable diseases explains how each one is checked during the exam.

Tuberculosis is the condition most applicants hear about. A chest X-ray is required if the first screening test is positive, if the applicant has signs or symptoms of TB, or if the applicant has known HIV infection. Applicants with suggestive findings must be referred to the local health department for sputum testing.

The civil surgeon cannot sign Form I-693 until the TB referral steps are finished. That process can take a long time, so plan ahead if a referral is needed.

Syphilis and gonorrhea testing depends on age and other factors that CDC sets. The testing age is the applicant’s age on the date the civil surgeon signs Form I-693, not the date USCIS decides the case. Hansen’s disease screening includes a history of skin lesions and a physical exam for signs of the disease.

Required vaccinations and how gaps are handled

Failing to present documentation of having received the required vaccinations, where those vaccines are age appropriate and medically appropriate, is its own Class A ground, separate from any disease. The statute lists mumps, measles, rubella, polio, tetanus and diphtheria toxoids, pertussis, influenza type B and hepatitis B. It also covers other vaccines recommended by the Advisory Committee on Immunization Practices, according to 8 U.S.C. § 1182.

COVID-19 is no longer a required vaccine for this purpose. USCIS announced that, as of January 20, 2025, officers would not issue requests for evidence, notices of intent to deny, or denials based on missing COVID-19 vaccine documentation. CDC removed COVID-19 from the list of required immigration vaccinations on March 11, 2025, as described in USCIS guidance on the vaccination requirement.

When a vaccine is not medically appropriate for you, the civil surgeon should mark that on Form I-693. USCIS then waives that vaccine. You don’t need a separate waiver application for this kind of medical exemption.

Physical or mental disorders with harmful behavior, and drug abuse or addiction

A physical or mental disorder becomes a Class A condition only when harmful behavior comes with it. The harmful behavior must be present or past, or likely to recur. A diagnosis alone does not settle the question, as USCIS guidance on physical and mental disorders explains.

Alcohol-related driving records are a common example. A record of DUI or DWI arrests or convictions can be evidence of this ground. If a civil surgeon diagnoses an alcohol use disorder and there is evidence of harmful behavior, the civil surgeon should record a Class A condition. Officers can order a new exam when a significant driving record was not considered the first time.

Drug abuse and addiction follow a different test. The civil surgeon uses the DSM, the American Psychiatric Association’s diagnostic manual, or another authoritative source as determined by the Director. Remission is judged by DSM criteria, not a fixed number of years. To show remission, the applicant must return to a civil surgeon for a new assessment, according to USCIS guidance on drug abuse and addiction.

Most applicants found to be drug abusers or addicts are ineligible for a waiver. Availability still depends on the benefit the applicant seeks. The result in these cases turns on the full record.

Conditions that do not bar on their own

A condition outside the Class A categories does not bar a green card on health grounds. USCIS says a condition the civil surgeon annotates that is neither Class A nor Class B does not make the applicant inadmissible on health grounds. It may still matter for other determinations, as USCIS guidance on other medical conditions states.

A Class B condition can still raise other questions. For example, health can be one factor in a public charge review. Public charge is the rule about whether an applicant is likely to rely heavily on government benefits. See USCIS guidance on the inadmissibility determination.

An accurate, complete history matters. If the file shows evidence the civil surgeon did not consider, an officer may order a new medical exam. Gaps in the record can lead to delay. Being open with the civil surgeon from the start is the safest approach.

When a finding comes up: what generally happens next

A civil surgeon can later record a former Class A condition as a Class B condition. Then the applicant is no longer inadmissible on health grounds, as USCIS guidance on the inadmissibility determination explains.

Some medical grounds can be addressed with a waiver under INA 212(g). USCIS says the applicant files a waiver either with Form I-485 and Form I-693, or in response to a request for evidence. Waiver forms include Form I-601, Form I-602 for refugees, and Form I-690 for waivers under Section 245A or 210 of the Immigration and Nationality Act, according to USCIS guidance on waiver authority.

Under 8 C.F.R. § 212.7, except as provided by 8 CFR 212.7(e), an applicant for an immigrant visa, adjustment of status, or a K or V nonimmigrant visa who is inadmissible under any provision of section 212(a) of the Act for which a waiver is available under section 212 of the Act may apply for the related waiver by filing the form USCIS designates, with the required fee, following the form instructions. Whether a waiver is available depends on the specific ground involved.

Medical questions in removal proceedings and talking with our office

Medical questions do not come up only in green card applications.

You may be in one of these situations. You received a civil surgeon finding and don’t know the next step. A relative’s diagnosis is holding up a family petition. A request for evidence or a re-examination order arrived, and you aren’t sure how to respond. Each situation turns on the facts in your own file.

If one of these describes you, talk through the details with our office. You can reach us by the contact form, by phone, or by WhatsApp. Consultations with our office are paid, and fees are discussed when you reach out.

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