You did everything right, paid the filing fees, went to a civil surgeon in Nassau County for your medical, and months later USCIS says your Form I-693 is “defective” or “insufficient.” Instead of the green card approval you expected, you are holding a Request for Evidence or even a denial that you do not fully understand. It feels like the ground just shifted under your feet and you are not sure where the mistake happened.
Many people in this position immediately blame themselves. They worry USCIS thinks they lied about a condition, skipped vaccines, or tried to hide tuberculosis. In reality, a large share of I-693 problems in Nassau tie back to how the exam was done and documented, not to anything the applicant did wrong. Civil surgeons may miss protocol changes, rely on outdated forms, or leave key parts of the I-693 incomplete, and those defects often stay hidden until an officer finally reviews the file.
At Kapoor Law Firm, we see this pattern regularly in Nassau County and across the New York City Metro area when we review RFEs and denials that point to I-693 issues. Because we focus closely on immigration filings and track updates to USCIS rules and CDC Technical Instructions, we understand how these medical defects happen and what can be done to try to fix or prevent them. In this guide, we walk through how I-693 failures actually occur, why they are often not your fault, and the steps we typically consider to protect an adjustment case.
Why USCIS Cares So Much About Form I-693
Form I-693 is not just another piece of paper in your adjustment of status packet. USCIS uses it to decide whether you are inadmissible on health-related grounds, based on disease, vaccination status, or certain dangerous behaviors. A civil surgeon, who is a doctor designated by USCIS, performs the exam and fills out the I-693 to show that you were screened according to CDC Technical Instructions and that you either meet the requirements or have a documented reason you do not.
Because the I-693 deals with public health and safety, USCIS officers treat it as a core part of your adjustment case. They do not only look at the overall result. They check whether the doctor used a valid version of the form, followed current tuberculosis and vaccination protocols, signed in the correct places, and sealed the exam properly. If the officer decides the exam is not compliant with the instructions, they can treat it as though there is no valid medical in the file at all and ask you to submit a new one.
There is also a timing element that many applicants and even some providers overlook. The I-693 is only valid for a defined period, and USCIS looks carefully at the date of the civil surgeon’s signature when they decide that. A medical done on an old form, signed outside the allowable window, or filed in a way that does not match the current validity rules can trigger an RFE or denial months later. In our adjustment work at Kapoor Law Firm, we factor these details into our filing strategy and review process, because a seemingly small technical defect on I-693 can stop an otherwise strong case.
How Civil Surgeon Workflows In Nassau Create Hidden I-693 Defects
From the applicant’s side, the medical exam feels simple. You bring your records, answer questions, get a physical, maybe some lab work, and pick up a sealed envelope. Behind the scenes, though, the civil surgeon’s office has to track shifting CDC Technical Instructions and USCIS form versions, which change from time to time. In Nassau County, we often see offices that rely on old checklists or internal habits instead of systematically updating their procedures when new guidance comes out.
One common pattern is that staff members, not the doctor, handle much of the paperwork using older templates. They may assume that the tuberculosis questions and vaccination chart are the same year after year, when in fact the CDC may have changed which TB tests are acceptable or how certain vaccines must be documented. The practice may continue using an older workflow without realizing that the official instructions have moved on. Everything looks normal to the office and to you, yet the form is now out of step with what USCIS expects.
Another recurring issue in Nassau is incomplete review before sealing the envelope. Some civil surgeons sign and seal the I-693 with unchecked boxes, missing dates, or unclear remarks like “see attached” with no proper attachment. Because the packet is sealed, most applicants never see these gaps. Months later, when a USCIS officer in a New York City field office finally reviews the file, the officer finds that the exam does not actually show compliance with the current instructions. The first time anyone realizes there was a defect is when USCIS issues an RFE or denial.
We have seen this kind of hidden failure often enough that we approach Nassau civil surgeon exams with appropriate caution. Our role is not to practice medicine, but to understand how local workflows line up, or fail to line up, with what USCIS and the CDC require on the I-693. As part of our hands-on approach, we ask specific questions about where and when the exam was done and compare that with the problems USCIS is flagging in its notice. That level of detail helps us pinpoint whether the issue is with the applicant’s history or with the way the exam was handled.
Outdated TB & Vaccination Rules: The Most Common I-693 Defects Locally
Tuberculosis screening is one of the most sensitive parts of the I-693. Civil surgeons must follow CDC Technical Instructions that specify which tests are acceptable, when a chest X-ray is required, and what must be written on the form if someone has a positive or indeterminate result. When those instructions change, offices that do not update their procedures promptly can end up using test methods that are no longer considered sufficient or documenting results in a way that does not match the new standards.
In practice, this can lead to medicals from Nassau that look complete to the applicant but do not meet current expectations. For example, the I-693 might show that a TB test was done, but there is no clear follow-up when it was positive. Or the civil surgeon may check a box suggesting TB screening is “not required” without noting the basis for that conclusion. USCIS officers reviewing the file may see that as a defect, because the exam does not show the full TB evaluation that the CDC instructions call for, so they ask for a new medical.
Vaccinations are another frequent source of I-693 medical defects. The form has a detailed vaccination record where the civil surgeon must either record the vaccines you received or explain, in the required boxes, why a certain vaccine is not medically appropriate or is not age-appropriate. In Nassau County, we often see vaccination tables that are partially blank, where the doctor or staff assumed that a verbal statement was enough. USCIS typically does not accept that. If the required box is not checked or the series is not properly documented, an officer can conclude that the I-693 is incomplete.
These TB and vaccination issues are not minor technicalities in the eyes of USCIS. The agency relies on the I-693 to confirm public health requirements are met according to current CDC guidance. If the civil surgeon in Nassau did not follow the latest instructions or did not record the steps in the way the form requires, the officer may issue an RFE demanding a new, fully compliant I-693. If that does not happen in time, or if the defect is discovered near the end of adjudication, it can contribute to a denial. At Kapoor Law Firm, we pay close attention to how these instruction changes interact with local medical practices so we can better advise clients on how to proceed.
Other I-693 Medical Defects We See In Nassau County Cases
Not every I-693 defect is about tuberculosis or vaccines. Many problems come from how the form itself is handled. A common issue in Nassau County is use of an outdated I-693 edition. Civil surgeons or their staff sometimes print bulk copies and keep using them after USCIS has released a new edition. From USCIS’s perspective, a medical on an obsolete form can be treated as invalid, even if the medical content is fine.
We also see basic completion errors. These include missing signatures or dates in the civil surgeon certification section, missing applicant signature where required, or pages that are simply not filled out. Another frequent problem is improper sealing of the envelope. USCIS expects the civil surgeon to seal the completed I-693 in a specific way. If the seal is broken or looks tampered with, or if the medical is submitted loose in the packet instead of sealed, officers may refuse to accept it and ask for a replacement.
Timing and validity are another layer. A medical exam can “expire” before USCIS finishes adjudicating the adjustment case. If a Nassau civil surgeon completed the exam too early relative to your filing date, or if your case took longer than usual and the medical fell outside the allowed window, USCIS might request a new one. Applicants often only learn about this after months of waiting, when they receive a notice stating that the I-693 is no longer valid for decision purposes.
Some of these defects are usually curable with an RFE, especially when there is no suggestion of fraud or misrepresentation. Others, if not corrected promptly, can help lead to denial. Our meticulous approach at Kapoor Law Firm includes looking for these mechanical issues when we review a case, because they are often preventable if identified early. When we receive an RFE that points to one of these problems, we focus first on understanding exactly which defect USCIS has identified, then we help the client decide the most efficient way to address it.
Why This Is Not Your Fault: Correcting Myths About I-693 Medical Defects
By the time someone reaches us with an “I-693 medical defect Nassau” problem, they often feel ashamed or defeated. Many believe that any medical issue must mean USCIS thinks they are dangerous, unhealthy, or dishonest. The language in RFEs and denials can sound intimidating, especially when it refers to inadmissibility or failure to establish eligibility. Without context, it is easy to assume the worst and to think the entire case is ruined.
In reality, there is a critical difference between a finding that someone is medically inadmissible and a finding that the medical exam itself is defective or incomplete. Most of the I-693 issues we see from Nassau fall into the second category. They involve missing checkboxes, outdated forms, incomplete vaccination tables, or TB screening that was not documented according to the instructions. These are failures in paperwork and process, often rooted in the civil surgeon’s workflow or understanding of current rules.
USCIS generally distinguishes between an applicant who misrepresented their health and a situation where the civil surgeon did not complete the form correctly. That does not mean the consequences are small, because a defective exam can still delay or block approval. It does mean that a defect does not automatically signal that USCIS thinks you lied. When we review these notices at Kapoor Law Firm, we focus on what the officer is actually saying about the form, rather than assuming they have made a judgment about your character or your underlying eligibility.
Once you see the problem clearly as a documentation or protocol issue, you can respond more effectively. Instead of panicking or giving up, the task becomes planning how to get a correct, compliant I-693 into the record and how to do that in a way that fits your deadlines and status. Our role is to help you separate myth from reality and then structure a response that addresses the true cause of the defect, not just the surface symptom.
What To Do If USCIS Flags An I-693 Medical Defect In Nassau
If you have received a Request for Evidence, Notice of Intent to Deny, or denial mentioning your Form I-693, the first step is to read the notice carefully and note the stated deadline. USCIS typically points to the specific problem, such as missing vaccination documentation, an outdated form edition, or an exam that is no longer valid. You want to understand exactly what the officer is asking for before taking action, because the wrong response can waste time you do not have.
Next, try to obtain a copy of the I-693 that was submitted, if you do not already have one. Sometimes the civil surgeon kept a copy, or your prior representative has a scan. Comparing the notice to the actual medical can show which sections are incomplete or out of date. In Nassau, we often find that the defect the officer cites matches a pattern we recognize, such as use of an older version of the form or a vaccination chart with large gaps and unchecked boxes.
Depending on the issue and the timing, you may have several options. For an RFE that simply asks for a new or corrected I-693, it often makes sense to schedule a fresh exam, ideally with a civil surgeon who is familiar with current CDC and USCIS requirements and willing to complete the form carefully. In some cases, we may suggest using a different provider than the one that created the defective exam, especially if the notice points to recurring problems with how that office fills out the form or handles TB and vaccination entries.
When there is a Notice of Intent to Deny or an actual denial, the strategy becomes more complex. You might need to respond with a new I-693 and a detailed explanation, file a motion to reopen, or consider refiling the adjustment if circumstances allow. The right move depends on your underlying status, how close you are to age limits or other critical dates, and how USCIS framed the problem. At Kapoor Law Firm, we look at the entire picture, not just the medical, to decide the best response for clients in the New York City Metro area.
One common mistake we see is sending partial records or letters from the civil surgeon when USCIS is really asking for a complete new I-693. Another is waiting too long to schedule the new exam, then running into delays that make it difficult to respond by the deadline. Having legal guidance early in the process can help you avoid those traps and coordinate your medical and legal steps so they work together rather than against you.
Preventing I-693 Problems Before You File Your Adjustment Case
If you have not filed your I-485 yet, or you are just now scheduling your medical exam in Nassau County, there are practical steps you can take to reduce the risk of I-693 defects. Start by gathering as much of your vaccination history as you can, including records from childhood, prior employers, schools, and any previous immigration medicals. The more documentation you bring, the easier it is for the civil surgeon to complete the vaccination table accurately and avoid guesswork.
When you call to schedule the exam, ask the civil surgeon’s office a few targeted questions. For example, you can ask which edition of Form I-693 they use and how they make sure they are following the latest CDC Technical Instructions for TB and vaccines. Their answers may give you a sense of how seriously they take these requirements. While you cannot control their internal processes, you can choose an office that shows awareness of current rules instead of one that simply says they always do things the same way.
Before the appointment, think about any prior TB tests or diagnoses you have had, and bring any records you can find. This helps the civil surgeon make the correct decisions about which tests or X-rays are needed and how to document them. Ask the office how they handle situations where additional TB evaluation is required, and whether they will clearly record the follow-up on the I-693 rather than just in their internal notes. Clear recording on the form matters because that is all USCIS sees.
We also encourage clients, when possible, to coordinate the timing of their medical with their adjustment filing strategy. You do not want to do the exam too early, have the I-693 sit unused for a long time, and risk it becoming stale before USCIS reaches your case. As part of our detail-oriented approach, we discuss with clients in Nassau and the broader New York City Metro area when to schedule the exam, how to choose a civil surgeon, and what to look out for so that the I-693 supports the filing instead of undermining it.
How Kapoor Law Firm Handles I-693 Medical Defects For Nassau Applicants
When someone comes to us with an I-693 medical defect issue, we start by diagnosing the problem as precisely as possible. We review the USCIS notice, the timeline of the adjustment case, and any available copy of the original medical exam. Our goal is to understand whether the issue is purely technical, tied to outdated instructions, or connected to a deeper question about admissibility, because the strategy differs in each scenario.
We then help clients plan the next medical step. That might mean returning to the original Nassau civil surgeon with clear instructions, or choosing a different provider who is better aligned with current CDC and USCIS requirements. We discuss what records to bring, what questions to ask, and how to time the new exam so that it will be valid when USCIS reviews it. Throughout, we keep an eye on related issues, such as work authorization, travel, and family members’ cases, so that one fix does not create new problems elsewhere.
For clients who have not yet filed, we build I-693 planning into the overall adjustment strategy. Our hands-on work includes going through key forms and supporting documents carefully, watching for small details that could cause big delays later. Because we maintain current knowledge of immigration practices in the New York City Metro area, including how local field offices treat I-693 problems, we can give grounded guidance rather than relying on generic national advice.
If you are dealing with an “I-693 medical defect Nassau” issue or want to lower that risk as you prepare your case, a focused review of your situation and your medical history can make a real difference. An initial consultation with Kapoor Law Firm gives you a chance to have your notices, timelines, and options evaluated with that level of attention to detail.
Protect Your Adjustment Case From I-693 Medical Defects
I-693 medical defects often feel like a sudden, unfair blow, especially when you trusted a civil surgeon in Nassau County and believed everything was in order. Once you understand that many of these problems come from how exams are documented and how protocols change, it becomes easier to see a path forward. With the right information and a careful strategy, you can often correct or prevent the kinds of defects that derail adjustment cases.
At Kapoor Law Firm, we approach these issues with the same meticulous, client-focused mindset that guides our immigration work in the New York City Metro area. If you have received an RFE, NOID, or denial tied to an I-693 medical defect, or if you want to build your case in a way that reduces that risk, we can review your situation and help you plan your next step.
Call (516) 806-4070 to schedule an initial consultation with Kapoor Law Firm.