The US Centers for Disease Control and Prevention (CDC) has issued new technical instructions for panel physicians tasked with evaluating individuals applying for immigrant or refugee status. These instructions focus on mental or physical disorders and associated harmful behaviors, as well as substance use disorders, as part of the immigration process.
The purpose of the immigration examination, performed by panel physicians, is to identify health-related conditions that could make an applicant inadmissible, referred to as Class A conditions. These include current physical or mental disorders with harmful behavior, disorders with a history of harmful behavior likely to recur, and substance use disorders.
Mental disorders are defined as health conditions characterized by alterations in thinking, mood, or behavior. Those with associated harmful behaviors, either current or likely to recur, are considered Class A conditions, while those without harmful behaviors are considered Class B conditions.
In diagnosing substance use disorders, panel physicians must use the criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), with at least 2 criteria needing to be met for a diagnosis of a substance use disorder. This includes disorders related to substances listed in the Controlled Substances Act (CSA), as well as non-CSA substances such as alcohol.
The panel physician must also identify harmful behaviors, defined as actions causing psychological or physical harm to the applicant or others or major property damage. Panel physicians can defer a diagnosis for 3-6 months to get additional medical evidence if they’re unable to determine if an applicant has an inadmissible condition.
For applicants with diagnosed mental or physical disorders, panel physicians must determine the remission status – whether the disorders are under control and when the last harmful behavior occurred. If an applicant claims remission but lack documentation, panel physicians must defer the process for 3-6 months.
In cases where panel physicians struggle to make a determination, they may refer the applicant to a mental health specialist for further evaluation. They can also consult the CDC’s Division of Global Migration Health for assistance.
The new instructions detailed in the document supersede all previous guidance and apply globally to all physicians conducting the health examination required for US immigration applicants.
1. The October 2025 Visa Bulletin published by the US Department of State brings long-awaited progress in green card queues. Those whose date of priority becomes current under the Dates for Filing chart can now submit an I-485 form, marking an important step towards obtaining their employment-based green card. The guide also explains basics of the Visa Bulletin, instructions for preparing an I-485 filing and recommendations for those whose I-485 is already pending. The goal is to ensure early and thorough preparation, leading to a better response timeline and prevention of avoidable delays.
2. As of November 2025, applicants for a US Green Card are required to submit their medical exam report alongside their initial application to streamline and expedite the process. The Department of State’s Visa Bulletin showed progress in several visa categories, with the F2A category showing notable progress. The overall processing time continues to increase. Kenyan immigrants, constituting a large portion of immigrants in the US, will be significantly impacted by these changes and must prepare their documents appropriately.
3. Access to affordable options for mandatory medical exams, required for individuals applying for US citizenship, remains a challenge in some states such as Kansas City. These exams need to be performed by qualified physicians and are usually not covered by most insurance policies. KC CARE Health Centre is one institution that offers these exams for a base cost of $250. Despite the high demand, limited physicians are currently qualified to conduct these exams, leading to longer waiting times for applicants. Some advocate for subsidies to ease the financial burden of these costly exams on immigrants.
4. The Refugee Health Program connects refugees, special immigrant visa holders, and asylum seekers with essential services. The program provides refugees with immunizations, HIV, STD and hepatitis B and C tests, emotional wellness support, tuberculosis testing and treatment, physical exams, and more. The program also assists with the certification of the Report of Medical Examination and Vaccination Record, required for a green card application.
