RFE HELP

[Seb928s 2]

Ok after about 7 months we get a RFE. Need help with this one and to do it as cheap as possible. My wife had her blood test and Chest X-Ray done in Poland and apprently between then and now someone last her paper work and CD for Chest X-Ray. Here is the whole RFE and we need your help because I don't really know if they want us to do an full medical again or just do a blood test for TB or blood test and X-Ray.

Request For Evidence

All medical examinations and vaccinations must be conducted and administered by a physician who is on the list of Civil Surgeons approved by USCIS.

All medical examinations must be submitted in an unopened envelope that has been sealed by the Civil Surgeon.

A review of the record indicates that the applicant entered the United States with a valid K1 nonimmigrant visa.

A review of the applicant's USCIS records fails to reveal on Form DS-3024 Department of State's medical form the results of the Chest X-Ray findings.

Form I 693: As such, the applicant is required to submit a Form I 693, Report of Medical Examination and Vaccination Record, that is properly completed and signed. The newest version of Form I693 includes the mdeical imformation as well as the vaccination record. Under new agency guidance, applicants two years of age or older are required to either have a tuberculin skin test or a new blood test ("interferon gamma release assays" or IGRA) performed.

NO TUBERCULIN SKIN TEST OR NEW BLOOD TEST: Current regulations now require that the tuberculin skin test (TST) or new blood test (called "interferon gamma relase assays" or IGRA"), and chest X-ray (if applicalbe) be performed on all applicants 2 years of age or older. The submitted Form I 693 relfects that the applicant has not had a TST,IGRA blood test or chest X-ray performed. A chest X-Ray is required in the following situations: when the reaction to the TST is 5 millimeters or more; if the result of an IGRA blood test is positive; or the reaction to the TST is less than 5 mm but the individual has signs or symptoms of either tuberculosis or immunosuppression.

If a chest X-ray is required, the applicant must also include a copy of the X-ray report with the submitted Form I 693 medical. However, only a full and formal radiologist's chest X-ray report, whether a copy or an original, will be accepted which must be signed by the radiologist or a qualified physician and be written on the offical hospital or medical office letterhead. If the chest X-ray shows an abnormality suggestive or active tuberculosis, The Civic Surgeon cannot complete the Form I 693 until the applicant receives and completes the treatment for tuberculosis(usually about 6 months).

That's everything on the RFE letter. We need help on getting an clear answer on what they are asking for.

[AandD 20]

Ok after about 7 months we get a RFE. Need help with this one and to do it as cheap as possible. My wife had her blood test and Chest X-Ray done in Poland and apprently between then and now someone last her paper work and CD for Chest X-Ray. Here is the whole RFE and we need your help because I don't really know if they want us to do an full medical again or just do a blood test for TB or blood test and X-Ray.

Request For Evidence

All medical examinations and vaccinations must be conducted and administered by a physician who is on the list of Civil Surgeons approved by USCIS.

All medical examinations must be submitted in an unopened envelope that has been sealed by the Civil Surgeon.

A review of the record indicates that the applicant entered the United States with a valid K1 nonimmigrant visa.

A review of the applicant's USCIS records fails to reveal on Form DS-3024 Department of State's medical form the results of the Chest X-Ray findings.

Form I 693: As such, the applicant is required to submit a Form I 693, Report of Medical Examination and Vaccination Record, that is properly completed and signed. The newest version of Form I693 includes the mdeical imformation as well as the vaccination record. Under new agency guidance, applicants two years of age or older are required to either have a tuberculin skin test or a new blood test ("interferon gamma release assays" or IGRA) performed.

NO TUBERCULIN SKIN TEST OR NEW BLOOD TEST: Current regulations now require that the tuberculin skin test (TST) or new blood test (called "interferon gamma relase assays" or IGRA"), and chest X-ray (if applicalbe) be performed on all applicants 2 years of age or older. The submitted Form I 693 relfects that the applicant has not had a TST,IGRA blood test or chest X-ray performed. A chest X-Ray is required in the following situations: when the reaction to the TST is 5 millimeters or more; if the result of an IGRA blood test is positive; or the reaction to the TST is less than 5 mm but the individual has signs or symptoms of either tuberculosis or immunosuppression.

If a chest X-ray is required, the applicant must also include a copy of the X-ray report with the submitted Form I 693 medical. However, only a full and formal radiologist's chest X-ray report, whether a copy or an original, will be accepted which must be signed by the radiologist or a qualified physician and be written on the offical hospital or medical office letterhead. If the chest X-ray shows an abnormality suggestive or active tuberculosis, The Civic Surgeon cannot complete the Form I 693 until the applicant receives and completes the treatment for tuberculosis(usually about 6 months).

That's everything on the RFE letter. We need help on getting an clear answer on what they are asking for.

Hi Seb,

We feel very badly for your situation and we are trying to understand your situation so we can make some helpful remarks.

We looked at these links to help understand the situation

http://www.uscis.gov/files/form/i-693.pdf

http://www.visa-21.com/DS-3024.pdf

We agree, the RFE is confusing. They are saying the 693 says she did not have a TB test???

How could you have gotten K1 approval if this was the case? very confusing.

It sounds like they are cutting and pasting out of sequence, hard to understand.

The part about the 3024 is confusing. Don't you only need one of those if the TB test indicates a need for a chest x-ray? In which case, if the TB test is good, that information on the 693 seems like it should be enough.

We would play it safe and look up a local civil surgeon, show the RFE, and perhaps they can provide more information on what USCIS will accept to satisfy the RFE, or refer you to someone else...

We wish would could give a helpful suggestion, but perhaps it would be incorrect, as the RFE is as confusing to us as it is to you.

Perhaps someone on VJ will chime in with some experience..

Good Luck!

[AandD 20]

Hi Seb,

We feel very badly for your situation and we are trying to understand your situation so we can make some helpful remarks.

We looked at these links to help understand the situation

http://www.uscis.gov/files/form/i-693.pdf

http://www.visa-21.com/DS-3024.pdf

We agree, the RFE is confusing. They are saying the 693 says she did not have a TB test???

How could you have gotten K1 approval if this was the case? very confusing.

It sounds like they are cutting and pasting out of sequence, hard to understand.

We would play it safe and look up a local civil surgeon, show the RFE, and perhaps they can provide more information on what USCIS will accept to satisfy the RFE, or refer you to someone else...

We wish would could give a helpful suggestion, but perhaps it would be incorrect, as the RFE is as confusing to us as it is to you.

Perhaps someone on VJ will chime in with some experience..

Good Luck!

Whoops....I see 3024 is for all adults Ancica did the chest x-ray and blood test too.

[Harpa Timsah 13,258]

It sounds like they are missing TB results. Sorry. I am not sure a CS would do only a Tb test and not the rest of the medical. The whole medical over again should only cost about $200 because it sounds like her shots are up to date. Good luck.

[JimVaPhuong 4,863]

This sounds like a long-winded way of saying that their records don't include the results of the chest x-ray done in Poland. Everything else they're saying is about what's required to fix the problem, and the legal requirements for getting it fixed.

A chest x-ray isn't needed for an AOS medical clearance unless the immigrant fails a TST or IGRA, or the civil surgeon thinks the immigrant has TB symptoms.

Find a civil surgeon in your area and schedule an appointment. Get the TST. It will take a couple of days to get the result. If it's negative (the red spot, if any, is less than 5mm) then you're good to go. Have the civil surgeon complete the I-693, put it in a sealed envelope, and give it to you. Send it to USCIS in response to the RFE.

It may cost a bit more, but if you've still got a copy of the DS-3025 then go ahead and have the civil surgeon transcribe the vaccinations and do the rest of the medical (a few minutes of poking and prodding - no big deal). It would be best to have the entire I-693 completed. That way there's nothing they can question about the medical requirements.

[marissaongiko 0]

we have the same situation . we received the RFE regarding the medical examination. if your medical is not more than one year you do not need to have a medical examination. but all you have to do is to go to the surgeon near to you place and fill up the form 1-693. and the doctor will tell you what to do. in my case my son and i have a skin test and you will update your vaccination after completing all of the vaccinations including flu shots give that to your surgeon and they will complete your papers in 2 or 3 days sealed . but still you have a copy on it. ops i forgt you have a blood test too. hope i helped you in little ways. thanks and goodluck

[Seb928s 2]

Thanks for the help. Tomorrow we are going in to the Civil Surgeon and having the medical done for 200$ we already have all the shots so we will not be needed anything more then the full exam. Will let you guys know how everything goes. Thanks for the replies. Later mates.

[AandD 20]

We are ahppy to hera good news from you

[Seb928s 2]

Went to the doctors today for the medical. Friday she has to go back in for them to look at the TB skin test and then if everything is ok sometime next week her blood work should be back so I'm hoping next Thursday I can get all the paper work and mail it back to CSC.

One other question I was told that some European countries have vacs for TB and she can't remember if she had it or not.

[JimVaPhuong 4,863]

Went to the doctors today for the medical. Friday she has to go back in for them to look at the TB skin test and then if everything is ok sometime next week her blood work should be back so I'm hoping next Thursday I can get all the paper work and mail it back to CSC.

One other question I was told that some European countries have vacs for TB and she can't remember if she had it or not.

The vaccination is called Bacillus Calmette-Guérin, or BCG. Having a BCG vaccination can cause a positive TST, but usually only within a few years of receiving the vaccine. The BCG vaccine is reasonably effective at preventing TB in children but much less in adults, so the vaccine is not routinely given to adults in many countries. It's unlikely that an adult who received a BCG vaccine as a child would give a positive TST as a result.

You'll know if your wife has a positive TST. The site where the injection was done will turn red and slightly raised. If the area of inflammation is 5mm or more then it's considered to be a positive result. In that case the civil surgeon will tell you to see a radiologist and get an x-ray. Less than 5mm would indicate her body contains some TB antibodies, but not enough to indicate a current active infection. This would be common in someone who was exposed to TB at some point in their lives, and either never developed an active infection or they've already recovered from the infection. No reaction at all indicates they've never been exposed to the bacteria.

[AandD 20]

Went to the doctors today for the medical. Friday she has to go back in for them to look at the TB skin test and then if everything is ok sometime next week her blood work should be back so I'm hoping next Thursday I can get all the paper work and mail it back to CSC.

One other question I was told that some European countries have vacs for TB and she can't remember if she had it or not.

Glad to hear things are moving in the right direction!

[Seb928s 2]

The vaccination is called Bacillus Calmette-Guérin, or BCG. Having a BCG vaccination can cause a positive TST, but usually only within a few years of receiving the vaccine. The BCG vaccine is reasonably effective at preventing TB in children but much less in adults, so the vaccine is not routinely given to adults in many countries. It's unlikely that an adult who received a BCG vaccine as a child would give a positive TST as a result.

You'll know if your wife has a positive TST. The site where the injection was done will turn red and slightly raised. If the area of inflammation is 5mm or more then it's considered to be a positive result. In that case the civil surgeon will tell you to see a radiologist and get an x-ray. Less than 5mm would indicate her body contains some TB antibodies, but not enough to indicate a current active infection. This would be common in someone who was exposed to TB at some point in their lives, and either never developed an active infection or they've already recovered from the infection. No reaction at all indicates they've never been exposed to the bacteria.

She has had the BCG in the past around 10 years ago when she was 14. Right now nothing has showed up but she goes in tomorrow at 10 in the morning to get it read. I'm really hoping it doesn't come out positive cause we really don't wanna go get the X-ray and pay more money for this AOS. You has it would become red and slightly raised. How red? Pink? Thanks guys

[JimVaPhuong 4,863]

She has had the BCG in the past around 10 years ago when she was 14. Right now nothing has showed up but she goes in tomorrow at 10 in the morning to get it read. I'm really hoping it doesn't come out positive cause we really don't wanna go get the X-ray and pay more money for this AOS. You has it would become red and slightly raised. How red? Pink? Thanks guys

No reaction would mean no color change whatever, other than maybe a tiny visible needle mark at the point of the injection.

Any visible color change is a reaction, but not necessarily a positive test result. There is no specific color gauge because it would vary, depending on the person's complexion. My son had a reaction to the test, and it started within minutes of getting the injection. It wasn't bright red, but it was noticeably more red than his normal skin color. It was clearly visible by the time we walked out of the civil surgeon's office. It was still there when we returned three days later to have it checked. The civil surgeon measured it at 4mm - not big enough to indicate a positive test result. He asked my step-son if he had any symptoms of TB (he didn't). He marked "negative" on the I-693.

We did mention that we had my step-son's x-ray results from the panel physician in Vietnam. The civil surgeon reviewed the x-ray and saw a small scar that might have indicated a prior TB infection, which would explain the reaction.

If your wife had a positive reaction then it would definitely be visible now. If you don't see any reaction then she's negative.

Edited January 28, 2011 by JimVaPhuong

[Tempo House 6]

I had BCG more than 25 years ago but my reaction to the test was positive. Could be a coincidence, of course. In any case my chest x-ray showed no symptoms.

[Seb928s 2]

She passed the TB test today sometime next week we will have all of our I-693 filled our and ready to mail the RFE back to CSC. Thanks everyone for your help.