Diagnosing Matter of L-A-D-

On May 22, The Board of Immigration Appeals issued a precedent decision, Matter of L-A-D-,1 rejecting a particular social group of “Mexican men with Schizoaffective Disorder.” The Board further held that “[i]n most cases, a particular social group based on a diagnosis alone will not be cognizable, considering the broad spectrum of severity and symptoms covered and the extent to which such symptoms are reasonably controlled by medication.”2

The case arose within the jurisdiction of the Tenth Circuit, a fact not mentioned in the decision. Nor does the circuit become evident upon reading; the Board cites precedent from the Fourth, Eighth, and Ninth Circuits (as well as an unpublished Third Circuit decision) in addition to a single Tenth Circuit opinion relating to “pattern or practice” based claims.

In its opinion, the Board does not survey the approaches of different circuits (as it did in Matter of M-R-M-S-,3 where, after discussing differing approaches, the Board concluded that in its view, the Tenth Circuit’s approach is the proper one). Nor does it mention in a footnote that its holding is contrary to the case law of any circuit (as in Matter of L-E-A-,4 where in fn 3, the Board recognized the Fourth Circuit’s differing  approach, and added “While it is not clear how the Fourth Circuit would apply that precedent to the facts here, this case does not arise in the Fourth Circuit.”). In other words, the Board in L-A-D- sought to state a rule of universal application. To understand the flaws in its reasoning, let’s first look at a 2021 decision of the Ninth Circuit that reached the opposite conclusion.

In Acevado Granados v. Garland,5 the question before the court was whether a particular social group defined by “intellectual disability” was cognizable. The BIA had said no, determining the group to be too broad, subjective, and amorphous to satisfy the requirement that a group be “particular” (meaning that it has clearly defined boundaries for who is in or out of the group).

The Ninth Circuit pointed out a significant error in the Board’s reasoning. The court noted that the BIA treated the term “intellectual disability” as if it had been used by a layperson. But the Ninth Circuit clarified that the petitioner “was diagnosed with ‘intellectual disability’ as that term is used within the psychological profession,” and was thus “limited to individuals with a specific diagnosis of ‘intellectual disability,’ as defined by the DSM-5.”6

The DSM-5 is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The Cleveland Clinic Online7 explains the manual as follows:

The first step in treating any health condition — physical or mental — is accurately diagnosing the condition. That’s where the DSM-5 comes in. It provides clear, highly detailed definitions of mental health and brain-related conditions. It also provides details and examples of the signs and symptoms of those conditions.

To be diagnosed with an “intellectual disability,” the DSM-5 requires that three specific criteria be satisfied. As the Ninth Circuit explained, while in lay usage, the term may refer to “a broad range of disorders” and may “lack precision,” “intellectual disability” “is a commonly recognized mental illness for which the DSM-5 details a well-established medical definition providing several universal, specific, immutable characteristics.” For these reasons, the court concluded that the characteristics of the diagnosis “provide a clear benchmark from which professional psychologists can determine who falls within the group.”8

The Ninth Circuit’s view makes perfect sense. As the point of the particularity requirement is to create a clear benchmark for inclusion (as the BIA has repeatedly said)9 the need for a qualified mental health professional to diagnose someone using a universal standard requiring specific and detailed findings is about as clear a benchmark as one could hope for. There is no guesswork involved; if the individual presents a diagnosis from an authorized professional, they are a member of the group.

So let’s compare the Ninth Circuit’s approach with that of the BIA. As stated above, Matter of L-A-D- involved a diagnosis of Schizoaffective Disorder. And the BIA considered this diagnosis some five years after the Ninth Circuit’s guidance in Acevado Granados. However, the Board in L-A-D- repeated the same mistake as it had made in the earlier Ninth Circuit case.

In L-A-D-, the Immigration Judge had actually found the particular social group to be valid, a decision that the Board reversed. Noting that to be particular, “a group must ‘be discrete and have definable boundaries’ and cannot “be amorphous, overbroad, diffuse, or subjective,’” the Board claimed that “[t]he term ‘schizoaffective disorder’ covers a broad spectrum of behavior exhibited with varying degrees of severity. The proffered group does not include any limiting language to narrow its breadth.”10

Was the Board correct? Using a simple Google search, I was able to find on the National Institute of Health’s online National Library of Medicine the DSM-5 definition of  Schizoaffective Disorder.11 There are four criteria that needs to be satisfied:

A. An uninterrupted period of illness during which, at some time, there is either a major depressive episode, a manic episode, or a mixed episode concurrent with symptoms that meet Criterion A for schizophrenia.

B. During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.

C. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness.

D. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

So only if a qualified mental health professional conducts an examination, finds that these four very specific criteria have been met, and then diagnoses the individual with Schizoaffective Disorder can class membership be established. This is not an instance of a broad, subjective term on which opinions can vary. As in Acevado Granados, the benchmark for inclusion is clear, and the group is particular.

However, the BIA ignored the above, claiming (as noted in the quote above) that the diagnosis was too broad and lacked limitations on its breadth.

A further look at the NIH online library quickly counters these assertions. Table 3.20 (which compares the DSM-IV and DSM-5 criteria for a number mental illnesses falling under the heading of “psychotic disorders”) lists the criteria for diagnosing Schizophrenia, Schizophreniform Disorder, Schizoaffective Disorder, Delusional Disorder, Brief Psychotic Disorder, Psychotic Disorder Due to Another Medical Condition, Substance/Medication-Induced Psychotic Disorder, Unspecified Schizophrenia and Other Psychotic Disorder, and Other Specified Schizophrenia Spectrum and Other Psychotic Disorder.12

The existence of seven distinct diagnoses within this one category heading demonstrates that each diagnosis does not cover a broad spectrum of severity and symptoms, but to the contrary, covers a very narrow and specific disorder. The breadth of the diagnosis is thus limited by the fact that behavior outside of its scope falls under the diagnosis for a separate mental illness.

All of the above leaves us to wonder how the Board reached its conclusion. Its decision offers no support for its view. It provided a very misleading quote from a Fourth Circuit decision, Temu v. Holder,13 stating that mental illness “covers a huge swath of illness that ranges from life-ending to innocuous.”14 But that quote refers to mental illness. Mental illness is not a specific diagnosis of one particular condition; it’s a term that covers everything. The group presented in L-A-D- was not defined by “mental illness,” but by a very specific and narrow diagnosis.

Furthermore, the Fourth Circuit in Temu found that the BIA had committed factual and legal errors in rejecting the PSG of “individuals with bipolar disorder who exhibit erratic behavior.”15 So the Board cherry-picked a quote from a decision finding that a specific diagnosis did constitute a valid PSG to support its own opinion reaching the opposite conclusion. The Board in L-A-D- did not engage in a detailed summary of Temu, or explain why it rejected that court’s approach.

Similarly, the only mention of the Ninth Circuit’s decision in Acevado Granados is an indirect one - the L-A-D- decision quotes a different Ninth Circuit decision, Andrade v. Garland,16 which involved not a medical diagnosis, but a broadly worded PSG of "Mexicans with mental health disorders characterized by psychotic features who exhibit erratic behavior." The court in Andrade distinguished the proposed group from that presented in Acevado Grenados, specifically finding that unlike the latter case, Andrade did not present a “clinical definition” and “documented diagnosis” of the illness in question.17 Again, the Board in L-A-D- cherry-picked a quote from Andrade referencing Acevedo Granados that misleadingly lacked the above context.

In L-A-D-, the BIA also determined that the specific diagnosis lacked social distinction, the requirement that the society in question views the group in question “as a sufficiently distinct group.”18 However, as with particularity, the Board ignored conflicting circuit case law.

First, in Acevado Granados, the Ninth Circuit ruled that the Board had erred in its social distinction analysis:

the BIA committed a legal error in holding that the proposed group did not meet the social distinction requirement because the record does "not support the determination that El Salvadoran society in general perceives [the proposed group] to be a meaningful social unit, distinct from the larger population of mentally ill individuals." The social distinction inquiry asks whether the "society in general perceives, considers, or recognizes persons sharing the particular characteristic to be a group," Pirir-Boc v. Holder, 750 F.3d 1077, 1082 n.4 (9th Cir. 2014), not whether the group is sufficiently distinguishable from other, similarly-persecuted groups, or whether the individual is a part of one group to the exclusion of other groups. The possibility that individuals with intellectual disabilities are subsumed in a larger group of persecuted individuals with mental illnesses does not control the social distinction analysis, because the question is whether individuals with intellectual disabilities are singled out for greater persecution than the general population.19

And inTemu v. Holder, the Fourth Circuit did not find society in general’s failure to distinguish between those with different types of mental illnesses to undermine a particular group’s social visibility (as social distinction was called at that time):

This conclusion does not show that Mr. Temu's group lacks social visibility: it shows that Mr. Temu's group lacks 20/20 visibility. The record is clear that Tanzanians view those with severe, chronic mental illness who exhibit erratic behavior as a group, since these individuals are singled out for abuse in hospitals and prisons and are specifically labeled “mwenda wazimu.” J.A. 137, 145. The nurses in this case explicitly said that “this is how we treat people who are mentally ill like you.” J.A. 135 (emphasis added). The fact that Tanzanians are overbroad in assigning this label to individuals does not show that social visibility is lacking. Though the persecution can be poorly aimed in theory, Tanzanians still appear to view the “mwenda wazimu” as a group, and that is all that social visibility requires.20

So in other words, both the Ninth and Fourth Circuits have held that where a group is defined in a way that is particular (i.e. by a narrow professional diagnosis), society at large need not define the group with the same specialized knowledge in order for the group to be socially distinct. Society at large doesn’t have to be able to state the difference between Schizophreniform Disorder, Schizoaffective Disorder, and Delusional Disorder; its members just need to view the group in question as distinct from society in general.

But the Board in L-A-D- discussed social distinction in two paragraphs, and made no mention at all of any circuit case law on the subject. 21

In summary, in L-A-D-, we have a decision in which the Board states a broad, general, and incorrect conclusion (“[t]he term ‘schizoaffective disorder’ covers a broad spectrum of behavior exhibited with varying degrees of severity. The proffered group does not include any limiting language to narrow its breadth”); provides no support for its conclusion, and then ignores circuit precedent to the contrary, perhaps hoping that no one would notice. Maybe an Attorney General will see fit to vacate the decision for lacking the vigorous legal analysis expected of BIA precedent decisions.22

But in the meantime, I offer the following pointers for those litigating and deciding these cases.

Documenting the claim: Claims based on a mental illness should be supported by a written diagnosis from a licensed mental health professional. Applicants should also file with the Immigration Court the DSM-5 criteria, and if available, a table such as the one referenced above listing related illnesses with their specific DSM-5 criteria, to demonstrate the narrow scope of each specific diagnosis. Presenting the testimony of a mental health professional on this point might also be considered.

Legal Arguments: As always in cases arising in the Seventh Circuit, it should be argued that Board precedents rejecting a PSG for lack of particularity and/or social distinction are inapplicable, given that circuit’s application of Matter of Acosta’s immutability requirement alone, and its rejection of social visibility (now social distinction) as an additional criterion. See Cece v. Holder,23 (applying the immutability test of Acosta alone to recognize "young women who are targeted for prostitution by traffickers in Albania," as a cognizable PSG; Gatimi v. Holder,24 (rejecting the related social visibility requirement for being inconsistent with other agency decisions).

In cases arising in the Fourth and Ninth Circuits, it should be argued that L-A-D-’s rejection of a specific diagnosis for PSG purposes directly conflicts with the decisions in Temu v. Holder and Acevado Grenados v. Garland for the reasons explained above.

In all other circuits, if the record contains clear evidence of a documented diagnosis, a description of the specifics of that diagnosis as per the DMS-5, and a comparison of the specific illness diagnosed with other related mental illnesses (demonstrating the narrow and specific breadth of the diagnosed illness in question), it can be argued that based on such record, the concerns expressed by the Board in L-A-D- about breadth and lack of limiting language of a diagnosis do not exist. Note that the Board in L-A-D- stated that a diagnosis alone will not be cognizable as a PSG “[i]n most cases,” which is different from “in all cases.” It can be argued that the analysis of the courts in Acevado Granados and in Temu should be persuasive where the specific concerns expressed by the Board in L-A-D- are successfully addressed by the facts of record.

Copyright 2026 Jeffrey S. Chase. All rights reserved.

Notes

1. 29 I&N Dec. 634 (BIA 2026).

2. Id. at 635.

3. 28 I&N Dec. 757 (BIA 2023).

4. 27 I&N Dec. 40 (BIA 2017).

5. 992 F.3d 755 (9th Cir. 2021).

6. 992 F.3d 755, 762.

7. Accessible at the following link: https://my.clevelandclinic.org/health/articles/24291-diagnostic-and-statistical-manual-dsm-5.

8. Acevedo Granados, supra at 762.

9. See, e.g., Matter of M-E-V-G-, 26 I&N Dec. 227, 239 (BIA 2014); Matter of W-G-R-, 26 I&N Dec. 208, 214 (BIA 2014); Matter of A-M-E- & J-G-U-, 24 I&N Dec. 69, 76 (BIA 2007).

10. Matter of L-A-D-, supra at 636.

11. Accessible at:  https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t20/.

12. Id.

13. 740 F.3d 887 (4th Cir. 2014).

14. Id. at 895.

15. Id. at 896 (stating that “the BIA's particularity analysis was based on legal error.”).

16. 94 F.4th 904 (9th Cir. 2024).

17. Andrade, supra at 912.

18. Matter of M-E-V-G-, supra at 238.

19. Acevado Granados, supra at 763.

20. Temu v. Holder, supra at 893.

21. L-A-D-, supra at 636-37.

22. See, e.g., Matter of A-B-, 27 I&N Dec. 316, 319 (A.G. 2018) (claiming mistakenly that a BIA precedent decision recognized a particular social group “without performing the rigorous analysis required by the Board’s precedents,” and then vacating the decision in question). While the assessment was inappropriate in A-B-, it would be most deserved in L-A-D-.

23. 733 F.3d 662 (7th Cir. 2013).

24. 578 F.3d 611, 616 (7th Cir. 2009).