What the Civil Surgeon Does and Does Not Evaluate

The civil surgeon's role is strictly medical. The civil surgeon evaluates the applicant for physical and mental health conditions that are grounds of inadmissibility under INA § 212(a)(1). The civil surgeon does not adjudicate criminal grounds of inadmissibility under INA § 212(a)(2) — that is exclusively USCIS's responsibility.

However, criminal history is directly relevant to the civil surgeon's evaluation in one important way: drug-related criminal convictions are a significant clinical indicator that the civil surgeon must consider when evaluating the applicant for substance use disorder. A conviction for drug possession, distribution, or a DUI can trigger a more thorough substance use disorder evaluation.

How Drug-Related Convictions Affect the Medical Exam

When an applicant has a drug-related criminal conviction, the civil surgeon is required to conduct a thorough substance use disorder evaluation. This evaluation goes beyond a standard medical history review and may include:

• Detailed questioning about the nature, frequency, and duration of substance use
• Review of any prior treatment history, including rehabilitation programs
• Assessment of current substance use and any signs of active disorder
• Evaluation of whether the applicant meets the DSM-5 criteria for substance use disorder
• Review of any court-ordered treatment or probation conditions related to substance use

When Criminal History Triggers a Class A Finding

A drug-related criminal conviction does not automatically result in a Class A inadmissibility finding on Form I-693. The civil surgeon must make an independent clinical determination that the applicant currently has a substance use disorder as defined by DSM-5 criteria.

If the civil surgeon determines that the applicant has a current substance use disorder, the finding is documented as a Class A condition — a ground of inadmissibility. This is separate from and in addition to any criminal inadmissibility that USCIS may find.

If the civil surgeon determines that the applicant does not currently have a substance use disorder — even with a prior drug conviction — the medical exam will not result in a substance use disorder finding. Past use that does not meet current DSM-5 criteria for disorder is not a Class A finding.

Preparing Your Client for the Substance Use Evaluation

Attorneys should prepare clients with drug-related criminal history for the substance use portion of the medical exam. Key preparation points:

Advise the client to be honest and accurate in their responses to the civil surgeon. Inconsistencies between the medical history and the criminal record can create credibility problems that are difficult to overcome.

If the client has completed a treatment program, gather documentation of that treatment before the exam. Treatment completion is a significant factor in the civil surgeon's assessment and can support a finding that the disorder is in remission.

If the client is currently in treatment or on probation with substance use conditions, bring documentation of compliance. Active engagement with treatment is a positive clinical indicator.

DUI Convictions and the Medical Exam

DUI convictions are a specific trigger for the civil surgeon's alcohol use disorder evaluation. A single DUI does not automatically result in a Class A finding, but multiple DUIs or a pattern of alcohol-related incidents will prompt a thorough evaluation. The civil surgeon will assess whether the applicant currently meets DSM-5 criteria for alcohol use disorder. Attorneys should review the client's full DUI history and prepare documentation of any treatment or sobriety programs completed.

Non-Drug Criminal History

Criminal convictions that are not drug or alcohol related — such as theft, assault, or fraud — do not directly affect the immigration medical exam. The civil surgeon evaluates health conditions, not criminal conduct. However, if the criminal history suggests a pattern of behavior that could be relevant to a mental health evaluation (such as violence-related offenses), the civil surgeon may conduct a more thorough mental health screening. Attorneys should be aware of this possibility for clients with violent criminal histories.