Your civil surgeon finished the exam and checked a box you did not know existed, and now USCIS says you are inadmissible. The box matters more than the diagnosis: three of the four health-related grounds can be waived, one cannot in an ordinary adjustment case, and the waiver you need depends entirely on which box was checked.
What Are the Four Health-Related Grounds of Inadmissibility?
INA 212(a)(1)(A), 8 U.S.C. 1182(a)(1)(A), makes a person inadmissible on four health grounds: (i) a communicable disease of public health significance; (ii) failure to present documentation of required vaccinations; (iii) a physical or mental disorder with associated harmful behavior; and (iv) drug abuse or addiction.
The first one is a closed list, not a doctor's judgment. 42 C.F.R. 34.2(b) defines a communicable disease of public health significance as gonorrhea, infectious Hansen's disease, infectious syphilis, active tuberculosis, the quarantinable diseases named in a Presidential Executive Order, and diseases CDC has determined may pose a public health emergency of international concern. That is the list. HIV has not been on it since 2010. Hepatitis B is not on it. Neither is diabetes, cancer, a heart condition, or a disability.
So when a client says their green card is in danger because of a chronic illness, the answer is usually that it is not. What they received was a Class B notification, which 42 C.F.R. 34.2(e) defines as a physical or mental health condition serious in degree or permanent in nature. A Class B finding is not a ground of inadmissibility. It is a note on a form. Class A is the one that bites.
The 212(g)(1) Waiver for a Communicable Disease
INA 212(g)(1) permits a waiver of the clause (i) ground, but only for a person who is the spouse, unmarried son or daughter, or minor unmarried lawfully adopted child of a U.S. citizen, lawful permanent resident, or someone issued an immigrant visa; or who has a son or daughter who is a citizen, lawful permanent resident, or immigrant visa holder; or who is a VAWA self-petitioner.
No qualifying relative, no waiver. And notice what is not in the statute: there is no extreme hardship element. That is 212(h) and 212(i) thinking and it does not belong here. What 212(g)(1) requires instead is that the applicant accept terms, conditions, and controls set after consultation with Health and Human Services, which in practice means arrangements for treatment and follow-up, and which the statute says may include a bond.
Active tuberculosis is the ground this provision was written for, and tuberculosis is treatable. A client who completes a documented course of treatment frequently stops being inadmissible at all. That is a better result than a waiver, and it is the first thing to check.
The waiver is filed on Form I-601 under 8 C.F.R. 212.7(a)(1) and (b)(1). One detail worth knowing: if the applicant is not competent to file personally, 8 C.F.R. 212.7(b)(1) permits the qualifying family member named in 212(g) to file it for them.
The 212(g)(2) Vaccination Waiver: the Route Most People Get Wrong
Three separate routes. They are not interchangeable.
The applicant gets vaccinated. INA 212(g)(2)(A). In most cases this is the entire answer and it costs a clinic visit.
The vaccine is not medically appropriate. INA 212(g)(2)(B). If the civil surgeon certifies that a vaccine is contraindicated, is not age appropriate, cannot be completed in the time available, or is a seasonal vaccine out of season, USCIS treats it as a blanket waiver and no separate application is required. The civil surgeon records the finding on the Form I-693.
Religious belief or moral conviction. INA 212(g)(2)(C). This one is not a blanket waiver, and it is where cases are lost. USCIS requires the civil surgeon to check the box stating that the applicant will request an individual waiver based on religious or moral convictions, and it requires a Form I-601 with documentation establishing the conviction. It also requires the applicant to demonstrate opposition to vaccinations in all forms. Not one vaccine. Not one ingredient. An applicant willing to accept some vaccines but not others does not meet that standard, and if a civil surgeon will support a contraindication finding, clause (B) is the better route.
Two current facts, because much of what is written about them online is out of date:
Since January 22, 2025, USCIS waives any and all requirements that an applicant for adjustment of status present proof of COVID-19 vaccination on Form I-693. It will not issue a request for evidence, a notice of intent to deny, or a denial on that basis.
A Form I-693 properly completed and signed by a civil surgeon on or after November 1, 2023 does not expire and retains its evidentiary value indefinitely. USCIS issued that guidance on April 4, 2024, replacing the old two-year clock. A form signed before that date is still good for two years from signature.
The 212(g)(3) Waiver for a Physical or Mental Disorder
Clause (iii) is the ground practitioners underestimate, because it has nothing to do with having a diagnosis. Inadmissibility requires a disorder and harmful behavior associated with that disorder, behavior that may pose or has posed a threat to the property, safety, or welfare of the applicant or others, either currently or as a history likely to recur. A diagnosis standing alone is not this ground. Say that to the client in those words, because the fear in the room is usually about the diagnosis.
This is also where alcohol-related driving records land. USCIS treats a substance use disorder involving a substance not scheduled under the Controlled Substances Act as a mental disorder, and alcohol is such a substance. One alcohol-related arrest can be enough to send an applicant back to the civil surgeon for re-examination. Clients volunteer that history casually in the examining room. They should not be hearing the question for the first time there.
The waiver under 212(g)(3) is discretionary and comes with real machinery. 8 C.F.R. 212.7(b)(2) requires a complete medical history including any hospitalization or institutional care, current findings, a psychiatric evaluation with prognosis, review by the Public Health Service, and then a statement from a clinic, hospital, specialized facility, or specialist in the United States approved by the Public Health Service confirming that it will evaluate the applicant and that complete financial arrangements have been made for that care. Bond is authorized by the statute. This is a months-long build, not a form you file on a Friday.
Is There a Waiver for Drug Abuse or Addiction?
There is no 212(g) waiver for drug abuse or addiction. Congress wrote 212(g) to reach clauses (i), (ii), and (iii) of 212(a)(1)(A) and stopped there. In an ordinary family-based or employment-based adjustment case, a finding under clause (iv) ends the case.
Which is exactly why the definition is the case. 42 C.F.R. 34.2(h) and (i) define drug abuse and drug addiction as a current substance use disorder or substance-induced disorder, mild for abuse and moderate or severe for addiction, involving a substance listed in section 202 of the Controlled Substances Act. Current. Full sustained remission under the diagnostic criteria is not a current disorder. That is the finding to work on with the civil surgeon before the form is signed, and to contest in a response if a notice of intent to deny issues. And marijuana remains a federally controlled substance. State legality is not an answer here, and clients assume it is.
Two exceptions, both real and both missed:
A refugee or asylee adjusting status is not limited to 212(g). INA 209(c), 8 U.S.C. 1159(c), permits DHS to waive any ground of inadmissibility in 212(a) other than the specified criminal and security grounds, for humanitarian purposes, to assure family unity, or when otherwise in the public interest. That reaches clause (iv). The application is Form I-602.
A nonimmigrant may be waived under INA 212(d)(3), which also reaches the health grounds, subject to conditions and bond.
What Forecloses These Cases
The civil surgeon's note is not a waiver. A notation that the applicant may qualify for a blanket waiver is a physician's opinion about a legal question. If USCIS says to file a Form I-601 and the response is that no waiver application is required, the case is riding on being right about that.
Not filing when invited. USCIS will sometimes state in a notice of intent to deny that a waiver is available and name the form. That notice is the window. Letting it close is how a waivable ground becomes a denial, and responding to USCIS demands on time is most of this work.
Assuming a court will fix it afterward. It generally will not. Under 8 U.S.C. 1252(a)(2)(B)(i) and Patel v. Garland, 596 U.S. 328 (2022), the federal courts have no jurisdiction to review judgments regarding the granting of adjustment of status, and that bar has been read to reach the factual findings underneath the judgment. An applicant who is not in removal proceedings and whose adjustment is denied on a health ground is generally left with a motion to reopen or reconsider and a refiling, not a lawsuit.
Filing the I-485 without the I-693. Since December 2, 2024, USCIS requires the medical examination report at initial filing rather than in response to a later request for evidence, and an application that arrives without it can be rejected outright.
What to Do Now
Get the Form I-693 in hand and read every box before anything is filed. Identify which clause of 212(a)(1)(A) is actually in play, because that determines whether what the case needs is a vaccine, a civil surgeon's certification, a Form I-601, a Form I-602, or an argument about the word current. If the waiver requires a qualifying relative, confirm the relationship before building anything. And if the ground is clause (iv), the work belongs in the medical record, not on the waiver form. If a medical finding is not the only problem in the file, a prior removal order for example, the waivers stack and the order of filing decides whether any of them can be granted.
One thing that runs in the applicant's favor: under 8 C.F.R. 212.7(a)(4)(ii), an approved immigrant waiver of inadmissibility is valid indefinitely, even if the person later abandons or loses permanent residence. This gets done once.
If a medical finding has stalled your case or produced a notice of intent to deny, the response deadline is the only thing that matters this week. Call (562) 495-0554 or book a consultation at blerner.timetap.com. If you are already in removal proceedings, that consultation is free.
This article is general information about United States immigration law and is not legal advice. Reading it does not create an attorney-client relationship. Immigration outcomes depend on the specific facts of each case. Law Offices of Brian D. Lerner, A Professional Corporation, 3233 E. Broadway, Long Beach, CA 90803. Brian D. Lerner is a Certified Specialist in Immigration and Nationality Law, The State Bar of California Board of Legal Specialization.