Rana v. Blanche: Medical Evidence Triggering Matter of M-A-M- Requires a Competency Finding; Credibility Is Not a Substitute

Introduction

In Rana v. Blanche (1st Cir. July 23, 2026), the United States Court of Appeals for the First Circuit granted a petition for review and remanded a removal case because the immigration judge (“IJ”) and the Board of Immigration Appeals (“BIA”) failed to apply the competency framework established by the BIA in Matter of M-A-M-.

The petitioner, Prakash Dhoj Rana, a Nepalese national, sought asylum, withholding of removal, and protection under the Convention Against Torture (“CAT”). During his removal hearing, he gave confused answers and could not recall details. After a continuance, Rana submitted a psychologist’s report stating that his ability to assist counsel and the court was “compromised” due to attention and concentration deficits. The IJ denied relief on adverse credibility grounds without making a competency inquiry or finding. The BIA dismissed the appeal, holding there were no “indicia of incompetency.”

The central issue on review was narrow but consequential: when the record contains evidence suggestive of mental incompetency, must the IJ conduct the Matter of M-A-M- inquiry, make a competency finding, and explain the reasoning?

Summary of the Opinion

The First Circuit held that the record compelled the conclusion that there were indicia of incompetency before the IJ—specifically, evidence of prior head trauma, confusion and memory problems during testimony, and a medical assessment indicating compromised ability to assist counsel and the court.

Because those indicia were present, the IJ had to follow Matter of M-A-M-: inquire further into competency, make an explicit competency determination, and articulate reasoning. The court rejected the notion that (1) positive demeanor, (2) representation by counsel, or (3) an adverse credibility determination could substitute for a competency finding. The court therefore granted the petition, vacated the removal order, and remanded for further proceedings.

Analysis

Precedents Cited

Matter of M-A-M-, 25 I. & N. Dec. 474 (BIA 2011)

Matter of M-A-M- supplies the controlling framework. It (1) presumes competence, (2) relieves the IJ of any competency analysis absent “indicia of mental incompetency,” but (3) imposes a mandatory process once indicia exist: additional inquiry, a competency finding, and articulated reasoning; if incompetency is found, procedural safeguards must be considered.

The First Circuit’s key move in Rana was to treat the threshold question—whether indicia exist—as enforceable and reviewable, and to hold that the record here compelled a “yes,” triggering the M-A-M- duties.

Cross-circuit acceptance of the M-A-M- framework

The opinion notes that other circuits have applied M-A-M- without questioning it, citing: Reid v. Bondi, 132 F.4th 109 (2d Cir. 2024); Hernandez Garmendia v. Att'y Gen., 28 F.4th 476 (3d Cir. 2022); Diop v. Lynch, 807 F.3d 70 (4th Cir. 2015); Camejo Gonzalez v. Garland, No. 20-60250, 2021 WL 4840962 (5th Cir. Oct. 15, 2021) (per curiam); Jatta v. Garland, No. 21-3584, 2022 WL 4365721 (6th Cir. Sep. 21, 2022) (per curiam); Lemus-Escobar v. Bondi, 158 F.4th 944 (9th Cir. 2025); Singh v. Bondi, 146 F.4th 918 (10th Cir. 2025); Joseph v. U.S. Att'y Gen., Nos. 22-14252 & 23-11632, 2025 WL 18420 (11th Cir. Jan. 2, 2025) (per curiam).

In practical terms, this cross-circuit line helps frame the First Circuit’s decision as an integration of the First Circuit into a broad, settled approach: M-A-M- is the operative baseline; the real disputes are about what counts as “indicia” and what process is required once they appear.

Calderon-Rodriguez v. Sessions, 878 F.3d 1179 (9th Cir. 2018)

The First Circuit cited Calderon-Rodriguez v. Sessions for a general description of M-A-M- as establishing a procedure to evaluate competency and ensure safeguards. Its role is contextual: it reinforces that M-A-M- is not a mere suggestion, but a structured framework recognized by appellate courts.

Lemus-Escobar v. Bondi, 158 F.4th 944 (9th Cir. 2025) and Reid v. Bondi, 132 F.4th 109 (2d Cir. 2024)

These cases support the proposition that once indicia appear, the IJ’s duty to address competency is affirmative and sua sponte—it does not depend on counsel raising the issue. The First Circuit adopted that principle explicitly, rejecting the government’s reliance on counsel’s presence as a reason to avoid the inquiry.

The opinion also echoed Lemus-Escobar’s caution that late-raised competency arguments may be viewed as “gamesmanship,” while simultaneously explaining why that concern did not apply on this record.

Mejia v. Sessions, 868 F.3d 1118 (9th Cir. 2017)

The First Circuit used Mejia v. Sessions for a specific operational requirement: when indicia exist, the IJ must articulate a competency determination and the reasoning. This citation anchors the remedy: not merely “take a look,” but make a reasoned, on-the-record finding.

Muñoz-Monsalve v. Mukasey, 551 F.3d 1 (1st Cir. 2008)

The government invoked Muñoz-Monsalve v. Mukasey to argue that counsel representation and lack of “significantly probative” evidence can support the adequacy of proceedings. The First Circuit distinguished it by positioning Muñoz-Monsalve as consistent with M-A-M-’s threshold: if no indicia exist, no inquiry is required; but once indicia exist, a competency inquiry and finding are mandatory. The court also reiterated Muñoz-Monsalve’s admonition that failure to timely raise competency can weaken a claim—then explained why counsel’s timing here was reasonable.

Drope v. Missouri, 420 U.S. 162 (1975)

The opinion cited Drope v. Missouri only to contrast criminal competency doctrine with immigration competency standards. M-A-M- draws from criminal competency concepts (understanding proceedings, consulting counsel, assisting defense), but immigration is civil and may proceed even where incompetency exists—provided safeguards ensure fairness.

Standard-of-review authorities: Alzaben v. Garland, Lopez-Quinteros v. Garland, Jianli Chen v. Holder

The court treated the “indicia of incompetency” question as a mixed question of law and fact, but “fact-intensive,” reviewing it for substantial evidence. It relied on Alzaben v. Garland, 66 F.4th 1 (1st Cir. 2023) (substantial evidence for fact-dependent mixed questions), and articulated the substantial-evidence reversal standard via Lopez-Quinteros v. Garland, 123 F.4th 534 (1st Cir. 2024) (quoting Jianli Chen v. Holder, 703 F.3d 17 (1st Cir. 2012)): reversal is warranted only when the record “compel[s]” a contrary determination.

Importantly, the First Circuit found that demanding standard satisfied: the record compelled a finding that indicia existed.

Legal Reasoning

1) The trigger is “indicia,” not a proven finding of incompetency

The court emphasized the staged structure of M-A-M-: the first step is not deciding incompetency, but deciding whether the record shows indicia that require further inquiry. The First Circuit held that Rana’s evidence met that threshold because:

  • He testified to a serious head injury (loss of consciousness and hospitalization).
  • He gave confused answers and had difficulty remembering details during the hearing.
  • A licensed psychologist’s report concluded his ability to assist counsel and the court was “compromised” due to attention and concentration deficits.

Those facts fit squarely within M-A-M-’s examples of indicia, including observed difficulty responding or staying focused and “medical reports or assessments.”

2) Positive demeanor and “readily answered questions” cannot negate medical indicia without a competency finding

The IJ and BIA relied heavily on the IJ’s observation that Rana was “positive [and] attentive” and “did not appear to lose focus.” The First Circuit rejected this as dispositive at the indicia stage, noting that a person may present as attentive yet still have impairments that compromise their ability to assist counsel or present evidence—especially when a medical professional says so.

3) Representation by counsel does not relieve the IJ’s sua sponte duty

The BIA stressed that Rana was represented and that counsel did not “assert incompetency.” The First Circuit held this misstates M-A-M-: the IJ’s obligation to assess competency, once indicia appear, is independent of whether counsel raises it. Counsel’s presence may be relevant later, when selecting safeguards, but it cannot erase the threshold duty to inquire and make a reasoned finding.

4) Credibility and competency are distinct; credibility determinations cannot substitute for competency findings

The court drew a bright line: competency is “distinct and antecedent” to credibility. If an applicant is incompetent (or potentially incompetent), M-A-M- safeguards might explain inconsistencies or enable more reliable evidence presentation. Thus, affirming an adverse credibility determination without addressing competency risks circularity: treating symptoms of impairment as proof of untruthfulness.

5) Remedy: remand for proceedings consistent with M-A-M-

Because the IJ never conducted the required inquiry or articulated any competency finding, and because the BIA’s “no indicia” conclusion was compelled to the contrary, the First Circuit vacated and remanded. It did not resolve Rana’s other challenges, treating the competency error as sufficient to require remand.

Impact

  • First Circuit enforcement of M-A-M- as a mandatory, reviewable procedure: The decision confirms that failure to recognize indicia of incompetency is not insulated by deference when the record compels the opposite conclusion.
  • Medical reports matter at the threshold stage: A professional assessment stating the noncitizen’s ability to assist counsel/court is compromised will often qualify as indicia requiring a formal competency inquiry and finding.
  • Demeanor-based observations are not a safe harbor: IJs cannot rely solely on perceived attentiveness to bypass competency procedures when other evidence suggests cognitive or attention impairments.
  • Credibility determinations may be vulnerable if competency is ignored: Because safeguards can affect how testimony is elicited and evaluated, a credibility finding reached without required competency analysis risks being set aside on review.
  • Clear message to practitioners: While the IJ bears the sua sponte duty, the opinion underscores that timely raising competency concerns is strategically and ethically important—both to protect the client and to avoid the “gamesmanship” critique noted in Lemus-Escobar and Muñoz-Monsalve.

Complex Concepts Simplified

  • “Indicia of incompetency”: Warning signs—observations or evidence—suggesting a person may not be able to meaningfully participate in the hearing (e.g., confusion, inability to answer, inability to stay focused, or medical evaluations documenting impairment).
  • Competency in immigration proceedings (from Matter of M-A-M-): Whether the noncitizen has a rational and factual understanding of the proceedings, can consult with counsel, and has a reasonable opportunity to present and challenge evidence.
  • “Sua sponte” duty: The judge must act on their own initiative. If indicia appear, the IJ must inquire even if neither side asks.
  • Credibility vs. competency: Credibility asks, “Is the testimony believable?” Competency asks, “Is the person able to participate reliably and fairly?” A person may be competent but not credible, or impaired in a way that affects testimony without implying dishonesty.
  • Substantial evidence / “record compels”: A deferential appellate standard: the court does not re-weigh evidence freely, but it will reverse if the evidence is so one-sided that any reasonable factfinder would have to reach the opposite conclusion.

Conclusion

Rana v. Blanche establishes a practical and enforceable rule in the First Circuit: when the record contains indicia of incompetency—including medical assessments and evidence of head trauma coupled with confusion—the IJ must conduct the Matter of M-A-M- inquiry, make an explicit competency determination, and explain the reasoning. The decision also clarifies that counsel’s presence and adverse credibility findings do not excuse this obligation, because competency is an antecedent fairness inquiry that can shape how credibility should be assessed.