The Legal Framework: INA § 212(a)(1)

The Immigration and Nationality Act (INA) § 212(a)(1) establishes health-related grounds of inadmissibility. These grounds apply to applicants seeking admission to the United States or adjustment of status to lawful permanent resident. The civil surgeon's role is to identify whether the applicant has any condition that falls within these grounds and to document the findings on Form I-693.

The two primary designations the civil surgeon uses are Class A and Class B. These designations have very different legal consequences for the applicant's case.

Class A Findings: Grounds of Inadmissibility

A Class A finding means the civil surgeon has determined that the applicant has a condition that constitutes a ground of inadmissibility under INA § 212(a)(1). Class A conditions include:

• Communicable diseases of public health significance (currently: tuberculosis, syphilis, gonorrhea, Hansen's disease, and certain other designated diseases)
• Failure to show proof of required vaccinations (vaccine-preventable diseases)
• Physical or mental disorders with associated harmful behavior
• Substance use disorder (drug or alcohol use disorder meeting DSM-5 criteria)

What a Class A Finding Means for the Case

A Class A finding is a significant adverse event in the immigration case. USCIS cannot approve the green card application while a Class A condition is unresolved. The applicant must either:

1. Treat and resolve the condition — if the Class A condition is treatable (such as active TB or syphilis), the applicant can undergo treatment, provide documentation of cure or remission, and return to the civil surgeon for a follow-up evaluation. If the civil surgeon determines the condition is resolved, the Class A designation can be removed.

2. Apply for a waiver — if the condition cannot be resolved or if the applicant wishes to proceed while the condition is being managed, a Form I-601 waiver application may be filed. Waiver approval is discretionary and requires demonstrating that the waiver is warranted under the applicable legal standard.

Attorneys should advise clients with Class A findings that the case will be delayed and that immediate action — either treatment or waiver preparation — is required.

Class B Findings: Conditions of Public Health Significance

A Class B finding means the civil surgeon has identified a condition that is of public health significance but does not rise to the level of a ground of inadmissibility. Class B conditions do not bar the applicant from receiving a green card.

Common Class B conditions include: latent TB infection (LTBI), pregnancy, physical or mental conditions that do not involve harmful behavior, and other conditions that the civil surgeon determines warrant notation but do not meet the Class A threshold.

A Class B finding is noted on Form I-693 and becomes part of the applicant's immigration record. USCIS will see the notation but will not deny the application based on a Class B finding alone.

Class B Follow-Up Requirements After Admission

Some Class B conditions come with a follow-up requirement after the applicant is admitted. The most common example is latent TB infection — applicants with LTBI may be referred to a local health department for follow-up evaluation and treatment after admission.

USCIS may issue a Form I-797 notification to the applicant after admission, directing them to report to a designated health authority for follow-up. Failure to comply with follow-up requirements can create complications in future immigration applications.

Attorneys should advise clients with Class B findings to comply with any follow-up requirements promptly and to keep documentation of their compliance.

The Distinction in Practice

The practical difference between Class A and Class B is stark: Class A stops the case; Class B does not. When reviewing a client's medical exam results, the first question attorneys should ask is whether any Class A conditions were identified. If yes, the case requires immediate strategic attention. If only Class B conditions are present, the case can proceed — but the attorney should advise the client on any follow-up obligations.