This is a recent update from the AILA Rome Chapter for the benefit of our readers. The State Department has substantially rewritten the FAM provisions relating to physical or mental disorders as medical grounds of inadmissibility. These significant changes, set forth at 9 FAM 40.11 N11, focus on physical or mental disorders with harmful behavior, and on substance-related disorders, corresponding to INA 212(a)(1)(A)(iii) and (iv), respectively.
The following is a summary of these sweeping revisions.
As before, the mere presence of a physical or mental disorder does not by itself render a visa applicant inadmissible to the United States under 212(a)(1)(A)(iii). The trigger to inadmissibility is the presence of associated harmful behavior.
Key Concepts of Mental Health
In this new section, the Department defines the key concepts of physical and mental health disorders:
A “physical disorder” is a clinically diagnosed medical condition where the focus of attention is physical manifestations.
A “mental disorder” is a health condition characterized by alterations in thinking, mood or behavior.
“Harmful behavior” is an action associated with a physical or mental disorder that causes (or has caused) one or more of the following:
1. Serious injury (psychological or physical) to the foreign national or others. An example of harmful behavior to the foreign national is attempted suicide. An example of harmful behavior to others is pedophilia.
2. A serious threat to the health or safety of the foreign national or others. An example of a serious threat to both the foreign national and to others is driving while intoxicated.
3. Major property damage.
NOTE: The Department emphasizes the following principle: Only harmful behavior that is associated with a physical or mental disorder is relevant for the purpose of determining a medical inadmissibility.
A “substance-related disorder” can involve one of the following:
1. Substance dependence – compulsive long-term use of alcohol or other psychoactive substance despite significant problems (physical, social, and others).
2. Substance abuse – a pattern of recurrent use of alcohol or other psychoactive substance despite adverse consequences or impairment.
Remission in the context of mental or substance-related disorders is defined as “a period of at least 12 months during which no substance use or associated harmful behavior have occurred.”
Class “A” medical conditions are those which render a visa applicant ineligible for a visa.
Class “B” medical conditions do not render a visa applicant ineligible for a visa, even though the applicant has a disease, disability or abnormality amounting to a substantial departure from well-being.
Alcohol Abuse or Dependence
The FAM changes stress that alcohol abuse or alcohol dependence constitutes a medical condition which can lead to inadmissibility. That said, a panel physician’s diagnosis of alcohol abuse or dependence alone does not make an applicant ineligible to receive a visa unless there is evidence of associated harmful behavior which has, or is likely to pose a threat to the property, safety or welfare of the foreign national or others.
Consular officers are instructed to refer nonimmigrant and immigrant visa applicants to panel physicians if the applicant has a single alcohol-related arrest or conviction within the past five years, or if the applicant has two or more such arrests or convictions within the past decade. Officers should also refer applicants to panel physicians if, in the absence of DUI arrests or convictions, there is any other evidence to suggest that the visa applicant has an alcohol problem.
Role of the Panel Physician
Panel physicians have a central role in evaluating the existence of a physical or mental disorder or a substance-related disorder that would render an applicant ineligible for a visa. In performing a medical examination, the panel physician is responsible (inter alia) for identifying and diagnosing physical or mental disorders (including alcohol-related disorders); identifying harmful behavior associated with a disorder; and determining the remission status of any previously diagnosed disorder.
Class “A” or Class “B” Medical Conditions
Panel physicians may make the following diagnoses with regard to applicants referred for examination:
Class “A”: The applicant has a physical or mental disorder with associated harmful behavior.
Class “A”: The applicant has a disorder characterized by substance abuse or dependence.
Class “B”: The applicant has a physical or mental disorder with no associated harmful behavior.
Class “B”: The applicant has a history of a physical or mental disorder with associated harmful behavior which is unlikely to recur.
Class “B”: The applicant’s substance abuse or dependence is in full remission.
Neither “A” nor “B”: The applicant has not been diagnosed as having a physical or mental disorder or a substance-related disorder.
Waivers for Immigrant Visa Applicants
An immigrant visa applicant who is determined to have a communicable disease of public health significance may be eligible for a waiver of the inadmissibility set forth in INA 212(a)(1)(A)(i).
An immigrant visa applicant who objects on religious or moral grounds to receiving required vaccinations against vaccine-preventable diseases may be eligible for a waiver of the inadmissibility set forth in INA 212(a)(1)(A)(ii).
An immigrant visa applicant who is determined to have a physical or mental disorder with associated harmful behavior may be eligible for a waiver of the inadmissibility set forth in INA 212(a)(1)(A)(iii).
An immigrant visa applicant diagnosed with substance abuse or addiction is NOT eligible for waiver relief of the inadmissibility set forth in INA 212(a)(1)(A)(iv).
Waivers for Nonimmigrant Visa Applicants
Consular officers may recommend waivers per 212(d)(3)(A) for any of the medical-related grounds of inadmissibility set forth in 212(a)(1)(A).