USCIS Case Studies & Practical Application 2 — Questions and Answers
Question 1: An applicant presents to a civil surgeon with a history of latent tuberculosis (LTBI) that was treated with 9 months of isoniazid 5 years ago. The civil surgeon performs a tuberculin skin test (TST) which is positive. What is the correct action?
- Require a chest X-ray and sputum cultures before completing the I-693
- Document the prior treatment and interpret the TST as expected; no further TB workup is required if the applicant is asymptomatic (Correct answer)
- Defer the exam and notify USCIS that the applicant has active TB
- Mark the applicant inadmissible due to the positive TST
Correct answer: Document the prior treatment and interpret the TST as expected; no further TB workup is required if the applicant is asymptomatic
A previously treated LTBI with a positive TST is expected; if there are no symptoms or signs of active TB, no additional workup is required and the civil surgeon documents the history.
Question 2: A 22-year-old applicant seeking a green card has never received any vaccinations due to religious beliefs. The civil surgeon explains vaccination requirements. The applicant requests a religious exemption. What is the correct process?
- The civil surgeon may grant the exemption directly on the I-693 without further documentation
- The applicant must submit Form I-601 and demonstrate religious opposition; USCIS adjudicates the waiver, not the civil surgeon (Correct answer)
- The civil surgeon skips the vaccination section and notes 'religious objection' on the I-693
- Vaccinations can be waived only by the CDC, and the applicant must contact them directly
Correct answer: The applicant must submit Form I-601 and demonstrate religious opposition; USCIS adjudicates the waiver, not the civil surgeon
Religious or moral objections to vaccinations require a waiver filed with USCIS via Form I-601; the civil surgeon cannot unilaterally grant this exemption.
Question 3: During a civil surgeon exam, an applicant discloses a history of intravenous heroin use that ended 3 years ago. The applicant is currently enrolled in a methadone maintenance program. How should the civil surgeon classify this finding?
- As a Class A condition because substance dependence is always permanently disqualifying
- As a Class B condition if the civil surgeon determines the applicant is in remission and the addiction is not current (Correct answer)
- Ignore it since the drug use occurred more than 1 year ago
- Refer the applicant to a psychiatrist before completing any part of the I-693
Correct answer: As a Class B condition if the civil surgeon determines the applicant is in remission and the addiction is not current
Past substance dependence that is in remission can be classified as Class B; current dependence would be Class A, but the civil surgeon must evaluate the current clinical status.
Question 4: A panel physician overseas completes a medical examination for an immigrant visa applicant. Upon arrival in the US, USCIS requests the applicant undergo a domestic civil surgeon exam. Which scenario most likely triggered this request?
- All immigrant visa holders must repeat the exam within 30 days of arrival regardless of overseas findings
- The panel physician's examination results were incomplete or the applicant's medical condition changed significantly after the overseas exam (Correct answer)
- The applicant changed their port of entry, automatically invalidating the overseas exam
- USCIS randomly selects 10% of all arriving immigrants for repeat exams as quality control
Correct answer: The panel physician's examination results were incomplete or the applicant's medical condition changed significantly after the overseas exam
A domestic civil surgeon exam may be required if the overseas exam was incomplete, if new conditions arose, or if the visa validity period lapsed before adjustment.
Question 5: An applicant's I-693 is submitted to USCIS but is missing the civil surgeon's signature on the vaccination record supplement. USCIS issues an RFE. What is the correct response?
- The attorney can sign the vaccination record on behalf of the civil surgeon
- The applicant must return to the same civil surgeon to complete and re-sign the form, then resubmit it in a sealed envelope (Correct answer)
- The applicant can obtain a new I-693 from any civil surgeon and combine it with the original
- Submit the original unsigned I-693 with a written explanation; USCIS will waive the signature requirement
Correct answer: The applicant must return to the same civil surgeon to complete and re-sign the form, then resubmit it in a sealed envelope
The civil surgeon must sign all applicable sections; the applicant must return to the civil surgeon to have the form properly completed and sealed before resubmission.
Question 6: A 45-year-old applicant has a chest X-ray showing calcified granulomas consistent with prior histoplasmosis, with no active pulmonary disease. The TST is negative. How should the civil surgeon proceed?
- Classify the applicant as Class A for pulmonary TB based on the X-ray abnormality
- Document the X-ray findings as consistent with prior fungal infection, classify as Class B notification condition, and complete the I-693 (Correct answer)
- Order sputum cultures for TB before completing the I-693
- Defer the exam until the applicant has a pulmonologist clearance letter
Correct answer: Document the X-ray findings as consistent with prior fungal infection, classify as Class B notification condition, and complete the I-693
Calcified granulomas with a negative TST and no active disease are consistent with prior fungal infection, warranting a Class B notation but not a Class A TB classification.
Question 7: An applicant discloses a history of schizophrenia that is well-controlled on medication with no hospitalizations in 10 years. The civil surgeon must determine admissibility. Which factor is MOST relevant to a Class A mental health finding?
- Whether the applicant has ever been prescribed antipsychotic medication
- Whether the mental disorder is associated with harmful behavior that is likely to recur (Correct answer)
- Whether the applicant's country of origin has a higher prevalence of mental illness
- Whether the applicant disclosed the condition voluntarily or it was discovered by the civil surgeon
Correct answer: Whether the mental disorder is associated with harmful behavior that is likely to recur
A mental disorder results in a Class A finding only if it is associated with harmful behavior; a well-controlled condition with no history of harm would typically not meet this threshold.
USCIS Case Studies & Practical Application 2
An applicant presents to a civil surgeon with a history of latent tuberculosis (LTBI) that was treated with 9 months of isoniazid 5 years ago.
The civil surgeon performs a tuberculin skin test (TST) which is positive.
What is the correct action?