J-J-G
27 I. & N. Dec. 808 (2020)
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Rule of Law:
When an applicant for cancellation of removal claims exceptional and extremely unusual hardship based on a qualifying relative's health, the applicant must establish that the relative has a serious medical condition. If the relative would accompany the applicant to the country of removal, the applicant must also demonstrate that adequate medical care for the condition is not reasonably available in that country.
Facts:
- J-J-G-, a native and citizen of Guatemala, is present in the United States without having been admitted or paroled.
- J-J-G- has five U.S. citizen children and a lawful permanent resident mother, all of whom are qualifying relatives for cancellation of removal.
- His 8-year-old daughter was diagnosed at birth with hypothyroidism, which requires regular medication to manage metabolic functions.
- His 11-year-old son was diagnosed with an anxiety disorder and ADHD but successfully completed therapy and was given coping strategies.
- J-J-G-'s mother has been diagnosed with hypertension, but her medical expenses are covered by state benefits and she is able to manage her own appointments and prescriptions.
- J-J-G- lives with and provides financial support to his mother.
- Testimony regarding the availability of medical care in Guatemala was conflicting; J-J-G-'s partner claimed medication for their daughter would cost $1,100 based on internet research, while his mother testified that she had previously received free medical care in Guatemala.
Procedural Posture:
- The Department of Homeland Security placed J-J-G-, the respondent, in removal proceedings before an Immigration Judge.
- J-J-G- applied for cancellation of removal, withholding of removal, and protection under the Convention Against Torture.
- The Immigration Judge conducted a hearing to adjudicate the applications for relief.
- On April 5, 2019, the Immigration Judge issued a decision denying all of J-J-G-'s applications.
- J-J-G- appealed the Immigration Judge's decision to the Board of Immigration Appeals.
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Issue:
To establish 'exceptional and extremely unusual hardship' for cancellation of removal based on a qualifying relative's medical condition, must an applicant demonstrate both that the relative has a serious medical condition and that adequate medical care is not reasonably available in the country of removal?
Opinions:
Majority - Acting Chairman Malphrus
Yes. To establish exceptional and extremely unusual hardship based on a qualifying relative’s health, an applicant must show the relative has a serious medical condition and that adequate medical care is not reasonably available in the country of removal. The court reasoned that while hardship is assessed cumulatively, claims centered on health require this specific, two-part showing. The applicant bears the burden of proof and must typically provide corroborating evidence, as their own testimony on medical matters is often insufficient. Here, J-J-G- failed to provide reliable evidence that his daughter's hypothyroidism could not be adequately treated in Guatemala, especially in light of his mother's conflicting testimony. The court also found that his son's mental health issues were not serious ongoing conditions and his mother's hypertension was well-managed. The court concluded that the combined economic, emotional, and medical factors did not meet the high 'truly exceptional' standard required for cancellation of removal, which must be substantially beyond the hardship normally expected from removal.
Analysis:
This decision clarifies and heightens the evidentiary standard for cancellation of removal claims based on medical hardship. By formalizing a two-part test (serious condition and unavailable adequate care), the Board of Immigration Appeals (BIA) provides immigration judges a more rigid framework for these specific claims. This precedent makes it more difficult for applicants to succeed on medical hardship grounds without strong, corroborating evidence, such as expert testimony or detailed reports on healthcare systems, rather than relying solely on personal testimony or general country condition reports. The case reinforces that the 'exceptional and extremely unusual hardship' standard is a very high bar, and that a lower standard of medical care in the home country is, by itself, insufficient to meet it.
