Communicable Disease
A communicable disease of public health significance identified under HHS regulations and CDC Technical Instructions can produce a Class A finding.
INA §212(a)(1) Immigration Medical Inadmissibility
Health-Related Grounds of Inadmissibility
U.S. immigration law recognizes four health-related grounds: certain communicable diseases of public health significance, failure to satisfy immigrant vaccination requirements, a physical or mental disorder with associated harmful behavior, and current drug abuse or drug addiction. A serious diagnosis, disability, medication history, hospitalization, or Class B condition does not automatically make a person inadmissible. The official medical classification, current CDC Technical Instructions, treatment history, and waiver or reexamination options must be reviewed.
Nationwide and international immigration representation through Messersmith Law Firm, P.A.
The Statutory Framework
The Four Health-Related Grounds
The medical examination is designed to classify these specific issues, not to exclude every person with a medical condition.
Vaccination Requirement
Immigrant visa and adjustment applicants generally must document required age-appropriate vaccines or qualify for an applicable waiver.
Disorder With Harmful Behavior
A physical or mental disorder is inadmissible only when associated harmful behavior meets the statutory and medical standards.
Drug Abuse or Addiction
A current substance-related disorder involving a controlled substance can create Class A inadmissibility. Ordinary immigrant waiver relief is generally unavailable.
A Narrow Immigration Test
Not Every Illness, Disability, or Diagnosis Is Inadmissible
The INA does not create a general exclusion for poor health. Cancer, diabetes, pregnancy, heart disease, physical disability, developmental disability, depression, anxiety, treated tuberculosis, latent tuberculosis infection, and HIV do not automatically establish a health-related ground.
Some conditions may be documented as Class B because they are serious or significant. Health can also arise in a separate public-charge analysis where legally applicable. Those issues should not be confused with a Class A ground under INA §212(a)(1).
Medical Classifications
Class A vs. Class B Conditions
A Class A condition corresponds to a health-related ground that renders the applicant inadmissible unless the condition is resolved, the applicant is reclassified, or an available waiver is approved.
A Class B condition is a serious or significant physical or mental abnormality, disease, or disability that does not amount to a Class A ground. The physician may record severity, treatment needs, prognosis, and follow-up.
- Class A generally blocks visa issuance or adjustment unless resolved or waived
- Class B generally does not create INA §212(a)(1) inadmissibility
- A treated Class A disease may be reclassified as Class B
- A specialist referral may be needed before classification
- The immigration agency makes the legal admissibility decision
INA §212(a)(1)(A)(i)
Communicable Diseases of Public Health Significance
The current routinely screened Class A diseases include active infectious tuberculosis, infectious syphilis, gonorrhea, and infectious Hansen disease. Quarantinable communicable diseases designated by executive order and diseases creating a public health emergency of international concern may also fall within the regulatory definition.
A positive test does not always mean permanent inadmissibility. Proper treatment can change the classification. Latent tuberculosis is generally Class B rather than infectious Class A tuberculosis.
- Active infectious tuberculosis—not every positive TB test
- Infectious syphilis—not every historical reactive result
- Gonorrhea confirmed under required testing procedures
- Untreated infectious Hansen disease
- Designated quarantinable or emerging diseases
Tuberculosis Screening
Positive IGRA, Latent TB, Abnormal X-Ray, and Active TB Are Different
Required Screening
Under current civil-surgeon instructions, applicants age two or older generally receive an interferon-gamma release assay.
Chest X-Ray When Indicated
A positive IGRA, known HIV infection, symptoms, or specified findings can require imaging and public-health referral.
Latent TB Infection
A positive IGRA without infectious disease is generally Class B2. Treatment is encouraged but not required to complete adjustment.
Infectious TB Disease
Confirmed or clinically diagnosed infectious tuberculosis is Class A until treatment and reclassification requirements are satisfied or a waiver is approved.
INA §212(a)(1)(A)(ii)
Immigration Vaccination Requirements
Immigrant visa and adjustment applicants generally must document required age-appropriate vaccinations under the statute, CDC criteria, and current ACIP-based Technical Instructions. Applicants are not necessarily required to finish every multi-dose series before the medical is signed; the physician determines which dose is due and medically appropriate.
Acceptable written records, laboratory evidence where permitted, reliable varicella history, and blanket-waiver annotations may satisfy particular requirements.
- Age appropriate under current Technical Instructions
- Required dose medically appropriate at the examination
- Written records generally required
- Contraindication and availability are physician determinations
- COVID-19 vaccination documentation is no longer required for adjustment applicants
INA §212(a)(1)(A)(iii)
Physical or Mental Disorder With Associated Harmful Behavior
Diagnosis alone is insufficient. The disorder and harmful behavior must be linked.
Qualifying Disorder
The physician identifies a physical or mental disorder using accepted medical standards.
Associated Harmful Behavior
The behavior must threaten or have threatened property, safety, or welfare and be associated with the disorder.
Current or Likely Recurrence
Current harmful behavior, or past harmful behavior likely to recur or lead to other harmful behavior, can be Class A.
Class B History
A past disorder and behavior may be Class B when recurrence is unlikely under the medical criteria.
Evidence Beyond Diagnosis
Hospital, police, treatment, medication, substance-use, family, school, and employment records may be relevant.
Waiver May Be Available
Form I-601 relief may include treatment, supervision, reporting, financial, or custodial conditions.
INA §212(a)(1)(A)(iv)
Drug Abuse or Drug Addiction
Current drug abuse or addiction is a medical classification under CDC Technical Instructions. The examination can consider controlled-substance use, symptoms, treatment, rehabilitation, laboratory evidence, arrests, convictions, prescriptions, and statements.
A single experiment, criminal charge, or conduct lawful under state law does not automatically establish the medical diagnosis. Federal controlled-substance law remains important, including for marijuana.
- Current Class A substance-related disorder generally creates inadmissibility
- Ordinary immigrant or adjustment waiver relief is generally unavailable
- Remission can support later reclassification
- Criminal controlled-substance inadmissibility is separate
- Alcohol is not a controlled substance but may relate to harmful behavior
Who Performs the Examination?
Civil Surgeon vs. Panel Physician
Civil Surgeon in the United States
Most adjustment applicants use a USCIS-designated civil surgeon who completes Form I-693, orders required testing, obtains consultations, and applies CDC instructions.
Panel Physician Abroad
Immigrant visa applicants generally must use the panel physician designated for the U.S. embassy or consulate. A private doctor ordinarily cannot replace that examination.
The Treating Doctor and Immigration Doctor Have Different Roles
A specialist can provide records and opinions. The designated immigration physician remains responsible for the official classification unless a formal reexamination or medical review applies.
Medical Examination Process
From Appointment to Immigration Decision
Collect Records
Obtain vaccination, TB, infectious-disease, psychiatric, hospitalization, substance-use, prescription, and treatment records.
Attend the Designated Exam
The physician verifies identity, reviews history, conducts the exam, and orders required testing.
Complete Referrals
A psychiatrist, health department, infectious-disease clinician, Hansen specialist, or addiction professional may need to resolve classification.
Physician Classifies
The official report identifies Class A, Class B, vaccination completion, blanket waivers, and follow-up.
Agency Reviews
USCIS or DOS determines inadmissibility, requests evidence, returns the report, or allows waiver processing.
Treat, Correct, Reexamine, or Waive
The applicant may resolve a temporary Class A condition, correct the report, obtain reexamination, or file the available waiver.
Current Form I-693 Rules
Submission, Edition, Signature, and Validity Problems
USCIS currently requires applicants who must submit Form I-693 or a partial I-693 to submit it with Form I-485. Failure to include required medical evidence can result in rejection.
Under USCIS policy effective June 11, 2025, a properly completed I-693 is generally valid only while the immigration benefit application with which it was submitted remains pending. A report tied to a withdrawn or denied application is not automatically reusable.
- Use the edition accepted on the filing date
- Confirm applicant and civil-surgeon signatures
- Do not open a sealed envelope when sealing is required
- Submit required evidence with Form I-485
- Do not assume an old I-693 remains valid for a new application
- Preserve a copy for review
Common RFE, Rejection, and Consular Problems
Errors That Can Delay or Derail the Case
Wrong Form or Missing Signature
An outdated edition, missing page, incomplete chart, or incorrect signature can make the report deficient.
Identity Error
Name, birth date, passport, A-number, photograph, or identification errors can call the report into question.
Vaccination Chart Incomplete
Missing dose dates, wrong waiver coding, or failure to transfer records can lead to an RFE or return.
TB Testing Error
Wrong test, omitted imaging, incomplete sputum process, or failed health-department coordination can prevent completion.
Unsupported Harmful-Behavior Finding
The record may identify a diagnosis without proving associated behavior, recurrence risk, or causal connection.
Incomplete Substance Record
Arrests, toxicology, marijuana history, prescriptions, rehabilitation, and remission may be misclassified without complete records.
Responding to a Class A Finding
Treatment, Reclassification, Waiver, or Legal Challenge
A Class A designation should be tied to the exact statutory category and current Technical Instruction. Some Class A conditions are temporary and resolve through treatment and reclassification. Others require a waiver. Current drug abuse or addiction generally requires remission and reexamination because ordinary immigrant waiver relief is unavailable.
When classification appears unsupported, identify the medical and legal error precisely. A specialist opinion, corrected laboratory evidence, complete hospital or rehabilitation records, and a new designated examination may be necessary.
Health-Related Waivers
Which Medical Grounds Can Be Waived?
Communicable Disease Waiver
INA §212(g) and Form I-601 may permit relief for qualifying applicants, often subject to treatment and public-health conditions.
Vaccination Waiver
Blanket waivers address medical appropriateness and availability. Individual relief may address sincere religious or moral convictions.
Harmful-Behavior Waiver
Form I-601 relief may include treatment, supervision, institutional, reporting, financial, or custodial safeguards.
Drug Abuse or Addiction
No ordinary immigrant or adjustment waiver is generally available. Reclassification is ordinarily required.
Nonimmigrant and Humanitarian Rules Can Be Broader
INA §212(d)(3)(A), refugee and asylee adjustment, T and U classifications, VAWA, and other special statutes may provide different waiver authority.
Preparing the Medical Record
Documents Needed for Health-Related Review
Official Immigration Medical Records
- Complete Form I-693 or Department of State medical forms
- Vaccination record and physician worksheets
- Class A and Class B codes, remarks, and referrals
- TB testing, x-rays, sputum, syphilis, gonorrhea, and Hansen records
- Laboratory and public-health records
- USCIS RFE, NOID, denial, consular refusal, or medical hold
- Prior exams, waivers, reexaminations, and medical-review decisions
Treatment and Corroborating Records
- Hospital, physician, psychiatric, counseling, and rehabilitation records
- Medication, pharmacy, laboratory, and toxicology records
- Police, court, arrest, incident, and protective-order records where relevant
- Recovery, support-group, and remission evidence
- Vaccination cards, registries, immunity, and contraindication records
- Specialist opinions on diagnosis, behavior, prognosis, and recurrence
- Treatment, supervision, reporting, insurance, and financial plans
Health-Related Grounds Cluster
Review the Specific Medical Issue
Communicable Disease
Review TB, syphilis, gonorrhea, Hansen disease, treatment, reclassification, and waivers.
Review communicable diseases →Vaccination Requirement
Review required vaccines, records, blanket waivers, and religious or moral-conviction relief.
Review vaccination rules →Mental Disorder and Harmful Behavior
Review diagnosis, associated behavior, recurrence, Class A findings, and waiver conditions.
Review harmful behavior →Drug Abuse or Addiction
Review substance-related findings, marijuana, remission, reexamination, and waiver limits.
Review drug-related grounds →Class A Medical Condition
Review how Class A findings are treated, challenged, reclassified, or waived.
Review Class A conditions →Immigration Medical Exam Problem
Review I-693 errors, RFEs, deficient exams, physician disputes, and corrective filings.
Review medical-exam problems →Experienced Immigration Counsel
Representation for Health-Related Inadmissibility
Messersmith Law Firm, P.A. represents applicants facing Class A findings, deficient I-693 reports, vaccination disputes, communicable-disease holds, harmful-behavior classifications, substance-related inadmissibility, consular refusals, RFEs, NOIDs, and I-601 waiver issues.
These cases often require coordination with civil surgeons, panel physicians, infectious-disease specialists, psychiatrists, addiction professionals, health departments, treating doctors, and immigration agencies. The medical record must be translated into the exact statutory and Technical Instruction framework.
The best strategy may be to prove the condition is Class B, complete treatment and obtain reclassification, correct an invalid medical form, establish remission, request medical review, or present a detailed waiver plan.
Frequently Asked Questions
Questions About Health-Related Inadmissibility
The result depends on the statutory category, current Technical Instructions, examination date, diagnosis, behavior, treatment, form validity, immigration classification, and waiver authority.
What are the four health-related grounds of inadmissibility?
INA Section 212(a)(1)(A) covers a communicable disease of public health significance, failure to satisfy the immigrant vaccination requirements, a physical or mental disorder with associated harmful behavior, and current drug abuse or drug addiction.
Does every serious medical condition make a person inadmissible?
No. Cancer, diabetes, heart disease, disability, pregnancy, HIV infection, latent tuberculosis, and most other medical conditions are not Class A inadmissible conditions merely because they are serious. The statutory Class A elements must still be established.
What is the difference between a Class A and Class B condition?
A Class A condition corresponds to a health-related ground of inadmissibility. A Class B condition is a serious or significant physical or mental abnormality, disease, or disability that does not itself make the applicant inadmissible but may require follow-up or reporting.
Who performs the immigration medical examination?
A USCIS-designated civil surgeon generally performs the examination for adjustment applicants in the United States and completes Form I-693. A Department of State-authorized panel physician performs the examination for immigrant visa applicants abroad.
Which communicable diseases currently create Class A inadmissibility?
The routinely screened conditions include active infectious tuberculosis, infectious syphilis, gonorrhea, and infectious Hansen disease. Quarantinable diseases and certain internationally significant emerging diseases may also qualify under the regulations and CDC instructions.
Is HIV infection a health-related ground of inadmissibility?
No. HIV infection was removed from the list of inadmissible communicable diseases effective January 4, 2010, and routine HIV testing is not part of the immigration medical examination.
Does a mental-health diagnosis alone make someone inadmissible?
No. There must be a physical or mental disorder and harmful behavior associated with that disorder that poses, may pose, or has posed a threat to property, safety, or welfare. Diagnosis alone is insufficient.
Is there a waiver for drug abuse or drug addiction?
There is generally no immigrant or adjustment waiver for current drug abuse or drug addiction. The issue may be overcome if a later examination properly finds sustained remission and removes the current Class A classification.
Can vaccination inadmissibility be waived?
Yes. Blanket waivers may apply when a vaccine is not age appropriate, contraindicated, unavailable, or otherwise not medically appropriate. A discretionary waiver may also be available for sincere religious beliefs or moral convictions opposing vaccinations in general.
Can USCIS reject Form I-485 for missing Form I-693?
Under the current USCIS filing rule, a required Form I-693 or partial Form I-693 generally must accompany Form I-485, and omission may result in rejection. Applicants should use the current edition and confirm the medical report remains valid for the application with which it is submitted.
Case-Specific Medical and Legal Review
A Diagnosis Is Not the Same as an Immigration Ground
Identify the exact Class A code, obtain the complete medical basis, apply current CDC Technical Instructions, distinguish Class A from Class B, correct form or testing errors, and determine whether treatment, remission, reexamination, waiver, or special humanitarian relief resolves the case.
This page provides general information and does not create an attorney-client relationship or constitute legal or medical advice. Consequences depend on the specific examination, records, diagnosis, classification, treatment, immigration category, agency, and law involved.