Persons applying to the U.S. Citizenship and Immigration Services (USCIS) are provided an exception to the English and civics requirement for naturalization if there is a medically substantiated mental impairment that is expected to last more than 12 months that interferes with the applicant’s ability to learn (e.g., traumatic brain injury, posttraumatic stress, severe anxiety and/or depression, etc.) Medical disability exceptions are established by way of a psychological evaluation and the completion of Medical Certification for Disability Exceptions (Form N-648) which is submitted to the USCIS as an attachment to the Application for Naturalization (Form N-400). The USCIS has strict requirements for the completion of this form to receive an exception. Within the mental health field, Clinical Psychologists are the only approved evaluators.

In 2019, USCIS provided an update to their requirements for sufficiency of medical certification for disability exceptions that clarifies that the USCIS may find an N-648 insufficient if there are findings of credible doubt, discrepancies, misrepresentation, or fraud as to the applicant’s eligibility for the exception. The regulations define a “medically determinable” developmental disability or mental impairment as one that “can be shown by medically acceptable clinical diagnostic techniques.” Since the applicant has the burden of proof, the psychologist completing the N-648 must provide medically substantiated evidence of the alleged disability.

In reviewing the request for the medical disability exception, the USCIS officer must focus on whether the psychologist sufficiently explained with enough supporting details that the applicant has a disability or impairment and its nature. The psychologist must also explain how the applicant’s disability or impairment prohibits the applicant from being able to demonstrate the English or civics requirements or both.

Over the years, I have evaluated numerous applicants for naturalization who were seeking a second psychological evaluation because their initial psychological evaluation was found to be insufficient and thus, they were provided with a either a continuance or denial. Invariably, what I discovered, was that the psychologist failed to properly medically substantiate the applicant’s impairment or the filling-out of the form did not comply with the USCIS’s strict standards.

Common Mistakes Leading to Denial of Medical Disability Waiver

• Contradictory information between the information on the form and other information provided to USCIS.
  
• Failing to provide a basic description of the applicant’s disability and/or impairment according to their indicated diagnosis
  
• Incomplete or missing clinical methods to diagnose medical disability and/or impairments (clinical interviews and records reviews are not sufficient as objective psychological testing must be included).
  
• Incomplete or missing explanation of how the disability and/or impairment(s) affect the applicant’s ability to demonstrate knowledge and understanding of English and/or civics.
  
• Failure to explain the origin, nature, and extent of the mental health condition.
  
• Failure to explain the nexus (causal connection) between the applicant’s inability to comply with the English or civics requirements or both. The psychologist’s explanation must be sufficiently detailed as well as specific to the applicant’s stated disability (rather than a generic, “one size fits all” explanation).
  
• Failure to use common terminology that a person without medical training can understand.
  
• Failure to correctly fill- out each question with the appropriate, corresponding responses. While the form may contain the information as requested by the USCIS, the applicant’s exception may still be turned-down because the information is placed in the wrong area of the form or written incorrectly.