The Legal Standard for Harmful Behavior

Under the Immigration and Nationality Act (INA), a physical or mental disorder is a ground of inadmissibility if it is associated with harmful behavior — behavior that has posed, or may pose, a threat to the property, safety, or welfare of the applicant or others. This standard is codified at INA § 212(a)(1)(A)(iii).

The harmful behavior standard is narrow and specific. It is not a general mental health assessment. The civil surgeon is not evaluating whether an applicant has a mental health condition — they are evaluating whether a current condition is associated with behavior that poses a current or future threat.

What Qualifies as Harmful Behavior

USCIS and the civil surgeon evaluate harmful behavior based on the following criteria: behavior that has posed a threat to the property, safety, or welfare of the applicant or others; or behavior that is likely to recur and pose such a threat in the future.

Examples of behavior that may qualify as harmful behavior include: recent violent episodes, threats of violence, destruction of property, self-harm with intent to injure, or behavior that endangered others. The behavior must be associated with a current physical or mental disorder — not simply a past episode that has been successfully treated.

What Does Not Qualify as Harmful Behavior

The following do not constitute harmful behavior under the USCIS standard:

• Having a mental health diagnosis (depression, anxiety, PTSD, bipolar disorder, schizophrenia, ADHD, etc.)
• A history of mental health treatment, therapy, or counseling
• Past psychiatric hospitalization that is not associated with current harmful behavior
• Taking psychiatric medications
• A history of suicidal ideation without current risk
• Past substance use that has been successfully treated
• Behavioral issues in childhood or adolescence that are not present in adulthood

How the Civil Surgeon Makes a Harmful Behavior Finding

The civil surgeon conducts a mental status examination as part of the immigration medical exam. This examination assesses orientation, affect, thought process, judgment, and insight. The civil surgeon also reviews the applicant's mental health history, including any history of psychiatric treatment, hospitalization, or behavioral incidents.

If the civil surgeon determines that an applicant currently has a physical or mental disorder associated with harmful behavior, they will document this finding on Form I-693. The civil surgeon will classify the finding as either a Class A condition (currently associated with harmful behavior) or a Class B condition (history of harmful behavior that may recur).

Class A vs. Class B Mental Health Findings

A Class A finding for a mental disorder associated with harmful behavior is a finding of inadmissibility. This means the civil surgeon has determined that the applicant currently has a condition associated with behavior that poses a current threat. A Class A finding is reported to USCIS and may affect the green card application.

A Class B finding indicates a history of a mental disorder associated with harmful behavior that has been treated or is in remission, but that may recur. A Class B finding is not a finding of inadmissibility, but it is noted on Form I-693 and may be reviewed by USCIS.

What Happens After a Harmful Behavior Finding

If the civil surgeon makes a Class A finding for a mental disorder associated with harmful behavior, USCIS will review this finding as part of the overall application. A Class A finding does not automatically result in denial of a green card — in some cases, a medical waiver (Form I-601) may be available.

If you receive a Class A finding, you should consult with an immigration attorney immediately. An attorney can advise you on whether a waiver is available, what evidence to gather, and how to respond to USCIS.

The Importance of Current Treatment

The most effective way to avoid a harmful behavior finding is to be receiving treatment for any mental health condition and to be stable at the time of the exam. If you have a history of a mental disorder that was previously associated with harmful behavior but you are currently in treatment and stable, the civil surgeon will evaluate your current status — not your history. Bringing documentation of your current treatment from your psychiatrist or therapist is strongly recommended.