Green card applicants must redo their entire medical exam if USCIS does not process their case within 2 years

You get an immigration medical exam from a USCIS-designated civil surgeon. It costs $200-500 (not covered by insurance). Blood tests, TB test, vaccination review, physical exam. You submit Form I-693 with your green card application. USCIS sits on your case for 2.5 years. Your medical exam expires (valid for 2 years from the civil surgeon's signature). You must get a new medical exam: another $200-500, another day off work, another set of blood draws. Some applicants have had to redo their medical exam 2-3 times because USCIS processing exceeded the validity period each time. So what? The medical exam validity period is 2 years, but USCIS processing regularly exceeds 2 years. The applicant pays the cost of USCIS's slowness — literally, in repeated $200-500 medical fees. This is a direct financial penalty imposed on immigrants for the government's inability to process paperwork on time. For a family of 4, re-doing medical exams costs $800-2,000 per round. Some families have spent $3,000-5,000 on repeated medical exams alone. Why does this persist? The 2-year validity period is set by USCIS policy (not statute — they could change it administratively). USCIS has no incentive to extend validity because the cost falls on the applicant, not the agency. Civil surgeons have no incentive to lobby for change because repeated exams are revenue. AILA has requested validity extensions during backlogs but USCIS has only granted temporary extensions during COVID, not permanent policy change.