When Medicine Meets Migration: How Health Issues Can Delay U.S. Immigration

What You Need to Know About Medical Delays on the Path to the U.S | Adobe Stock

By Junayd Rehman, Associate Attorney at Waypoint Immigration USA

For many, the U.S. immigration process is a complex journey filled with paperwork, interviews, and background checks. But one critical part that often catches people off guard is the medical examination. This isn't just a routine checkup, it’s a gatekeeper. And sometimes, health conditions can delay, or even derail, an immigration case entirely.

Let’s break down how medical issues, ranging from missing vaccines to pregnancy, tuberculosis, or other treatable conditions, can affect the immigration timeline and what you can do about it to be as proactive as possible.

The Role of the Immigration Medical Exam

Before a person is granted lawful permanent residency (i.e., a green card), they must pass a medical examination conducted by a U.S. Citizenship and Immigration Services (USCIS)-designated civil surgeon (if inside the U.S.) or a panel physician (if abroad).

This is not an optional step. The exam is required by law and designed to make sure the immigrant isn’t inadmissible on public health grounds. It includes:

• A physical exam

• A mental health evaluation

• Testing for certain communicable diseases (like tuberculosis or syphilis)

• A review of vaccination records

• Screening for drug and alcohol use

• Questions about past or present medical conditions

The results are then recorded on Form I-693 and submitted to USCIS as part of the green card process.

Medical Grounds of Inadmissibility

U.S. immigration law lays out four broad medical grounds that can make someone inadmissible (ineligible to enter or stay in the country):

1. Communicable diseases of public health significance

2. Failure to show proof of required vaccinations

3. Physical or mental disorders associated with harmful behavior

4. Drug abuse or addiction
   

Let’s look at some of the most common health-related reasons immigration gets delayed and what can be done.

1. Tuberculosis (TB): A Major Cause of Delay

Tuberculosis is a global concern and a high-priority screening item during the medical exam. USCIS and the CDC have very specific guidelines.

If the applicant tests positive on the initial tuberculin skin test (TST) or IGRA blood test, they’re required to undergo a chest X-ray. If the X-ray or further evaluation suggests active TB, the person must complete treatment, which can last six to nine months or longer, before they can proceed with their application.

Even if the TB is latent (meaning you carry the bacteria but aren’t contagious), you may still be asked to undergo treatment or monitoring before being cleared.

Why it delays immigration:

• Treatment is time-consuming

• Clearance requires documentation from the treating doctor

• Immigration authorities must confirm the disease is no longer a public health risk
  

2. Incomplete Vaccination Records

Immigrants must show proof of certain vaccinations, including but not limited to:

• Measles, mumps, and rubella (MMR)

• Tetanus and diphtheria toxoids

• Pertussis

• Hepatitis B

*Note the COVID vaccine is now optional, and Influenza vaccines are only required seasonally.

If you're missing vaccines, the civil surgeon will typically administer them during the medical exam or refer you to another clinic to get them done.

Why it delays immigration:

• Some vaccines require multiple doses over weeks or months

• COVID-19 vaccination requirements may vary depending on updated public health guidance, and requirements have changed several times

• Missing or foreign-language vaccine records can create confusion or require translation/certification
  

Pro tip: Get your vaccination records translated and certified before your exam and check the CDC website or consult with your lawyer to know which vaccines you’ll need.

The Civil Surgeon might administer a blood test in lieu of requesting records (to determine if you have the right antibodies), but this can also cause delays.

3. Pregnancy: A Special but Complicated Case

Pregnancy itself is not a medical ground of inadmissibility, but it can complicate the medical exam process.

For example:

• Some vaccinations (like MMR or varicella) can’t be given during pregnancy

• X-rays (for TB screening) might be postponed unless absolutely necessary

• Certain TB medications used for treatment may be contraindicated during pregnancy
  

In such cases, the physician may defer parts of the exam until after the pregnancy or issue a waiver if appropriate. However, this often leads to delays in the green card process unless USCIS accepts a temporary exception.

Why it delays immigration:

• Incomplete vaccination series

• Delayed TB screening

• Risk vs. benefit concerns with medications or procedures
  

In some cases, USCIS will hold the application until the applicant can complete the exam postpartum.

4. Chronic Conditions That Require Treatment

Conditions like diabetes, hypertension, epilepsy, HIV, or mental health disorders are not automatically disqualifying, but the immigration doctor will assess whether:

• The condition is well-managed

• It affects the applicant’s ability to be self-supporting

• It’s linked to any harmful behavior, especially in mental health cases
  

For instance, someone with a history of severe psychiatric illness coupled with violent behavior may be flagged as inadmissible. Or someone with untreated substance use disorder may face denial.

Why it delays immigration:

• The civil surgeon may require medical records or a clearance letter from your specialist

• USCIS may issue a Request for Evidence (RFE) asking for more documentation

• In serious cases, a waiver may need to be filed (which can take months)
  

5. Drug Use or Addiction

This is a big red flag under U.S. immigration law. Even casual marijuana use, legal in many U.S. states, can cause major problems in an immigration context.

If you admit to drug use during the medical exam or in a prior criminal record, you may be classified as a drug abuser or addict and found inadmissible.

Why it delays (or derails) immigration:

• A finding of current addiction typically leads to mandatory denial

• Past drug use might require counseling records or a psychological evaluation

• A waiver of inadmissibility can be hard to get and very time-consuming
  

Bottom line: Seek legal counsel long before you see a doctor, to determine the immigration effects of any drug issues past or present. You will have to be truthful during the medical exam and on all your paperwork, so you need to understand the consequences early on.

What Can You Do?

1. Be proactive. Schedule your medical exam early in the process and bring your full medical history.

2. Talk to your immigration attorney about any known health issues in advance.

3. Start treatment early if you know you have TB or other conditions that may require time.

4. Keep detailed records of all treatments, vaccinations, and medical consultations.

5. Stay in communication with your doctor and your legal team, especially if something unexpected comes up.
   

Final Thoughts

Medical delays are frustrating but often manageable. The key is not waiting until the last minute and working closely with both your doctor and your immigration attorney to ensure all requirements are met as smoothly as possible.

In the world of immigration, a clean bill of health isn’t just a blessing, it can also be the final green light you need to move forward with your American dream.