dismissed EB-1A Case: Anesthesiology

U.S. Citizenship 
and Immigration 
Services 
MATTER OF A-T-
Non-Precedent Decision of the 
Administrative Appeals Office 
DATE: APR. 3, 2019 
APPEAL OF NEBRASKA SERVICE CENTER DECISION 
PETITION: FORM 1-140, IMMIGRANT PETITION FOR ALIEN WORKER 
The Petitioner seeks classification as an individual of extraordinary ability in the field of 
anesthesiology. See Immigration and Nationality Act (the Act) section 203(b)(l)(A), 8 U.S.C. 
§ 1153(b)(l)(A). This first preference classification makes immigrant visas available to those who 
can demonstrate their extraordinary ability through sustained national or international acclaim and 
whose achievements have been recognized in their field through extensive documentation. 
The Director of the Nebraska Service Center denied the petition, concluding that the Petitioner had 
satisfied two of the initial evidentiary criteria, of which he must meet at least three. 
On appeal, the Petitioner contends that he meets two other criteria, relating to making original 
contributions of major significance in the field, 8 C.F.R. § 204.5(h)(3)(v), and performing in a leading 
and critical role, 8 C.F.R. § 204.5(h)(3)(viii). He maintains that he qualifies for the classification. 
Upon de nova review, we will dismiss the appeal. 
I. LAW 
Section 203(b )(1 )(A) of the Act makes visas available to certain immigrants if: 
(i) the alien has extraordinary ability in the sciences, arts, education, business, or 
athletics which has been demonstrated by sustained national or international 
acclaim and whose achievements have been recognized in the field through 
extensive documentation, 
(ii) the alien seeks to enter the United States to continue work m the area of 
extraordinary ability, and 
(iii) the alien's entry into the United States will substantially benefit prospectively the 
United States. 
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Matter of A-T-
The term "extraordinary ability" refers only to those individuals in "that small percentage who have 
risen to the very top of the field of endeavor." 8 C.F.R. § 204.5(h)(2). The regulation at 8 C.F.R. 
§ 204. 5(h)(3) sets forth two options for satisfying this classification's initial evidence 
requirements. First, a petitioner can demonstrate a one-time achievement (that is, a major, 
internationally recognized award). If the petitioner does not submit this evidence, then he or she must 
provide documentation that meets at least three of the ten criteria listed under 8 C.F.R. 
§ 204.5(h)(3)(i)-(x) (including items such as qualifying awards, published material in certain media, 
and scholarly articles). 
Where a petitioner meets these initial evidence requirements, we then consider the totality of the 
submitted material in a final merits determination and assess whether the record, as a whole, shows 
sustained national or international acclaim and demonstrates that the individual is among the small 
percentage at the very top of the field of endeavor. See Kazarian v. USCIS, 596 F.3d 1115, 1119-20 
(9th Cir. 2010) (discussing a two-part review where the documentation is first counted and then, if 
fulfilling the required number of criteria, considered in the context of a final merits determination); 
see also Visinscaia v. Beers, 4 F. Supp. 3d 126, 131-32 (D.D.C. 2013); Rijal v. USCIS, 772 F. Supp. 
2d 1339, 1343 (W.D. Wash. 2011). This two-step analysis is consistent with our holding that the 
"truth is to be determined not by the quantity of evidence alone but by its quality," as well as the 
principle that we examine "each piece of evidence for relevance, probative value, and credibility, both 
individually and within the context of the totality of the evidence, to determine whether the fact to be 
proven is probably true." Matter ofChawathe, 25 I&N Dec. 369, 376 (AAO 2010). 
11. ANALYSIS 
The Petitioner indicates that he is an anesthesiologist who has trammg in adult neurosurgical 
anesthesiology and pediatric neuroanesthesiology, and is qualified to conduct intraoperative 
neurophysiological monitoring. The record shows that he has a doctor of medicine degree and a degree 
of bachelor of medicine and bachelor of surgery. His resume states that he has worked as a professor 
of anesthesiology in India, a staff fellow physician anesthesiologist at the 
and ____ as well as a medical director for 
, a subsidiary of 
The Director concluded that the Petitioner meets the participation as a judge criterion under 8 C.F .R. 
§ 204.5(h)(3)(iv) and the authorship of scholarly articles criterion under 8 C.F.R. § 204.5(h)(3)(vi). 
The record supports this conclusion. The Petitioner has presented documentation from the Journal of 
Anaesthesiology Clinical Pharmacology and the Journal of Obstetric Anaesthesia and Critical Care, 
professional publications, confirming that he served as their reviewer and reviewed manuscripts 
between 2006 and 2017. In addition, the record confirms that he has authored scholarly articles that 
are published in professional journals, including 
that appeared in the Journal of Anaesthesiology Clinical Pharmacology , and 
that appeared in the Indian Journal 
of Urology. While the Petitioner has satisfied two criteria under 8 C.F.R. § 204.5(h)(3)(iv) and (vi), 
2 
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Matter of A-T-
as we will explain below, he has not met the initial evidence requirements of satisfying at least three 
criteria. 1 
Evidence of the alien 's original scientific, scholarly, artistic, athletic, or business-related 
contributions of major significance in the.field 8 C.F.R. § 204.5(h)(3)(v). 
To satisfy this criterion, the Petitioner must establish that not only has he made original contributions 
but that they have been of major significance in the field of anesthesiology. Major significance in the 
field may be shown through evidence that his research findings or original methods or processes have 
been widely accepted and implemented throughout the field, have remarkably impacted or influenced 
the field, or have otherwise risen to a level of major significance in the field. See USCIS Policy 
Memorandum PM-602-0005.1, Evaluation of Evidence Submitted with Certain Form 1-140 Petitions; 
Revisions to the Adjudicator's Field Manual ( AFM) Chapter 22. 2, AFM Update AD 11-14 8-9 (Dec. 
22, 20 I 0), https://www.uscis.gov/sites/default/files/USCIS/Laws/Memoranda/i-l 40-evidence-pm-
6002-005-l. pdf. 
The record is insufficient to demonstrate, by a preponderance of the evidence, 2 that the Petitioner has 
satisfied the criterion under 8 C.F.R. § 204.5(h)(3)(v). On appeal, the Petitioner claims that he meets 
this criterion because his articles have appeared in "some of the most prestigious journals in the field"; 
other scientists have cited to and relied on his findings; the 
has referenced his research in its guidance to medical professionals; he has 
collaborated with to develop monitoring software, and the field of 
anesthesiology has shown interest in his ___ device. 
The Petitioner's written work and citation frequency are insufficient to satisfy this criterion. 
According to a statement he initially submitted in support of the petition, he has "published about 50 
peer-reviewed publications that include original research manuscripts, review articles, case reports 
and peer-reviewed abstracts" and that his articles have appeared in "some top-ranking journals." 
Evidence of publication in respectable journals and presentation in reputable forums shows that the 
Petitioner has shared his research. To satisfy this criterion, he must establish that the reaction from 
the field upon the dissemination of his work confirms that the value of his research rises to the level 
of "contributions of major significance" in the field, as required under 8 C.F.R. § 204.5(h)(3)(v). 
The Petitioner asserts that his citation frequency establishes that he meets this criterion. He offers 
documents from Clarivate Analytics, listing "baselines-citation rates" for clinical medicine. He, 
however, has not explained how citation information about clinical medicine relates to his 
contributions in anesthesiology , the field in which he claims extraordinary ability. Similarly, the 
record includes documents relating to citation percentile in the research area of "anesthesia, intensive 
1 The Petitioner has not alleged, and the record does not demonstrate , that he has received a major, internationa lly 
recognized award. See 8 C.F.R. § 204.5(h)(3). As such, he must provide documentation that meets at least three of the 
ten criteria listed under 8 C.F.R. § 204.5(h)(3)(i)-(x) to satisfy the initial evidence requirements. 
2 lf a petitioner submits relevant, probative, and credible evidence that leads U.S. Citizenship and Immigration Services 
(USCIS) to believe that the claim is "more likely than not" or "probab ly true," the petitioner has satisfied the 
"preponderance of the evidence" standard of proof. See USCIS Policy Memorandum PM 602-0005.1, supra, at 4. 
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Matter of A-T-
care medicine, medicine, surgery," but they do not specifically list information about his contributions 
in the field of anesthesiology. 
Regardless, the Petitioner has not shown that the number of citations his work has garnered confirms 
his research qualifies as contributions of major significance in the field. On appeal, he submits a 
Google Scholar printout, indicating that his most cited article, published in 2013, received 7 4 citations, 
and his second most cited article, published in 2002, received 39 citations. 3 The printout reveals that 
many of his articles have not garnered any citation. According to a letter from the editor­
in-chief of , the Petitioner's 2013 article was the 
journal's second most cited article. The evidence shows that the journal's h5-index and h5-median, 
which relate to its standing in the field, are relatively low as compared to the top ten publications in 
anesthesiology. Evidence regarding the Petitioner's citation rate does not confirm that his articles 
"have provoked widespread commentary or received notice from others working in the field, or entries 
(particularly a goodly number) in a citation index which cite [his] work as authoritative in the field." 
USCIS Policy Memorandum PM 602-0005.1, supra, 8. 
Although the Petitioner has submitted some examples of other scientists citing to and relying on his 
research, he has not demonstrated that his articles have been cited as authoritative in the field or have 
influenced the field in a significant way. He offers incomplete copies of articles that cite to his studies, 
but these documents reference his work among many other studies, and do not include an in-depth 
discussion about his research. For example, the 2017 article 
' cites one of his articles among at least 108 other sources, and the 
2016 article 
cites his work among at least 52 studies. The Petitioner has not shown that his findings are 
authoritative or have otherwise risen to the level of contributions of major significance in the field. 
Similarly, the record is insufficient to confirm that the Petitioner's research on fatigue in anesthesia 
practice qualifies as contributions of major significance in the field. He has submitted an 
document entitled This document cites 
two of the Petitioner's articles, among 47 studies, to support the proposition that "[t]he consequences 
of fatigue have serious implications for patient safety and the overall wellness of anesthesia 
professionals." It advises that"[ m ]anaging fatigue has the potential to improve the quality of patient 
care and outcomes to spur excellence in clinical and professional practice." The Petitioner has not 
established that references to his research in the document or other articles are indicative of 
his work's significant impact in the field. Rather, these publications acknowledge that his studies have 
added to the general pool of knowledge, which, without evidence of significant influence in the field, 
is insufficient to satisfy this criterion. 
Furthermore , while the record shows that the Petitioner was involved with inventing 
which, according to a consultant anesthetist at the . 
is "a fluid delivery system ... that reduces harmful effects by preventing the medical 
errors from occurring ," he has not shown that has been widely used in the field . 
a professor in the Department of Anesthesiology in the __________ at 
3 According to an article " " which the Petitioner offers on appeal, the citation frequency 
referenced in Google Scholar might include citations in non-scholarly writings. 
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Matter of A-T-
states that - "represent[ s] the categories of drugs most commonly used 
in anesthesia: 
drugs." explains that the "product contains seven syringe ports" that 
"interlock with only one designated syringe," which "allows the medical provider to assure that the 
syringe contains the correct drug and is correctly administered intravenously." The Petitioner, 
however, has not presented evidence verifying that his invention has been widely used in the field. 
Rather, according to two 2017 email correspondence in the record, researchers could not confirm if 
had ever been tested or used in a clinical setting. The evidence therefore does not establish 
that his invention constitutes contributions of major significance in the field. 
While the record includes an unsigned agreement between 
and the Petitioner, it does not show that he is "collaborat[ing] with a major American 
company, regarding the development of next-generation monitoring software for 
patients under anesthesia," as he has claimed in the appellate brief The unsigned agreement specifies 
the rights and obligations of the parties regarding the use of data communication 
protocols for the exchange of data between products and third party medical equipment. 
It does not discuss the Petitioner's work or impact in the field of anesthesiology. 
Finally, the reference letters in the record similarly are insufficient to demonstrate that the Petitioner 
has made original contributions of major significance in the field. See 8 C.F.R. § 204.5(h)(3)(v). 4 
Some of these letters discuss in detail the nature of the Petitioner's work, claiming he has advanced 
the field. For example, the record includes letters from , a professor of anesthesiology 
in the School of Medicine at the in New Zealand; a professor in 
the Department of Neurosurgery at the and 
, a professor of women's health at the These letters 
state that other scientists have cited to and relied on the Petitioner's work. The letters, however, are 
insufficient to confirm that his impact or influence in the field has risen to the level of "major 
significance." See Kazarian, 596 F.3d at 1122 (finding that "letters from physics professors attesting 
to [a petitioner's] contributions in the field" were insufficient to meet this criterion). The Petitioner 
has not demonstrated that his work - which may have resulted in incremental advancements in the 
field, as such are expected in any original research - qualifies as contributions of major significance 
in the field. See USCIS Policy Memorandum PM-602-0005.1, supra, at 8-9 ("Letters that lack 
specifics and simply use hyperbolic language do not add value, and are not considered to be probative 
evidence that may form the basis for meeting this criterion."). 
The above and other letters not specifically discussed, as well as other evidence in the record, show 
that the Petitioner's work has added to the general pool of knowledge in the field. They are, however , 
insufficient to confirm widespread commentary and acceptance of his work , or that the field of 
anesthesiology has regarded his research as authoritative. See Visinscaia, 4 F. Supp. 3d at 134-35 
(upholding a finding that a ballroom dancer had not met this criterion because she did not demonstrate 
her impact in the field as a whole). Letters that repeat the regulatory language but do not sufficiently 
explain how an individual ' s contributions have already influenced the field significantly are 
insufficient to satisfy this criterion. See Kazarian v. USCIS, 580 F. 3d 1030, 1036 (9th Cir. 2009), 
aff'd in part, 596 F. 3d 1115, 1122 (9th Cir. 2010). Based on the evidence in the record , the Petitioner 
4 While not every letter in the record is discussed, all were considered in reachin g our conclusion. 
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Matter of A-T-
has not shown, by a preponderance of the evidence, that he has made original contributions of major 
significance in the field of anesthesiology. 
Evidence that the alien has performed in a leading or critical role for organizations or 
establishments that have a distinguished reputation. 8 C.F.R. § 204.5(h)(3)(viii). 
On appeal, the Petitioner maintains that he satisfies this criterion based on the work he has performed 
for his employer, 5 For a leading role, the evidence must establish that the petitioner is or 
was a leader. See USCIS Policy Memorandum PM 602-0005.1, supra, at 10. If the petitioner claims 
to have performed a critical role, he or she must establish that the role is or was of significant 
importance to the outcome of the organization or establishment's activities. A supporting role may be 
considered "critical" if the petitioner's performance in the role is or was important in that way. It is 
not the title of the petitioner's role, but rather his or her performance in the role that determines whether 
the role is or was critical. Id 
According to an August 2018 letter from the Petitioner serves as the medical 
director for . a subsidiary of The letter describes his duties and work 
for ___ and sufficiently shows that he performs a leading and critical role for his employer. 
The record, however, is insufficient to demonstrate that qualifies as an organization or 
establishment that has a distinguished reputation, as required under 8 C.F.R. § 204.5(h)(3)(viii). 
According to a 2018 Tech Journal Hub article, and approximately 20 other 
companies are "top players" in the global intraoperative market. A 2015 
NFIB article calls one of "the top five companies in the nation in their field." 
claims that is its most productive subsidiary and is affiliated with more than 50 
hospitals. The record includes a list oflocations where offers its services, and a document 
showing that the awarded contracts to While these documents 
verify that is active in the market, they are insufficient to establish that it has a 
distinguished reputation. The Petitioner has not pointed to any legal authority to support a position 
that "distinguished reputation" under 8 C.F.R. § 204.5(h)(3)(viii) can be shown through a company's 
size and clients. 
The Petitioner has also submitted an article posted on the website, 
noting that and other companies donated to a surgical mission trip to India. The Petitioner, 
however, has not demonstrated that this information, which relates to the company's one act of 
generosity, is sufficient to confirm that his employer has a "distinguished reputation." In light of the 
above, the Petitioner has not satisfied this criterion because he has not presented "[e]vidence that [he] 
has performed in a leading or critical role for organizations or establishments that have a distinguished 
reputation. " See 8 C.F.R. § 204.5(h)(3)(viii). 
5 While the record appears to show that the Petitioner works for in addition to its subsidiary, 
in his appellate brief, he has not alleged that he performs in a leading or critical role for ____ We will 
therefore focus our discussion on his role for 
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III. CONCLUSION 
The Petitioner has not submitted the required initial evidence of either a one-time achievement or 
documents that meet at least three of the ten criteria. As a result, we need not provide the type of final 
merits determination referenced in Kazarian, 596 F.3d at 1119-20. Nevertheless, upon a review of 
the record in its entirety, we conclude that it does not support a finding that he has established the 
acclaim and recognition required for this classification. 
The Petitioner seeks a highly restrictive visa classification, intended for individuals who are already 
at the top of their respective fields, rather than for individuals progressing toward the top. USCIS has 
long held that even athletes performing at the major league level do not automatically meet the 
"extraordinary ability" standard. Matter of Price, 20 I&N Dec. 953, 954 (Assoc. Comm'r 1994). 
Here, the Petitioner has not shown that the significance of his academic, scholarly, research, and 
professional accomplishments is indicative of the required sustained national or international acclaim 
or that it is consistent with a "career of acclaimed work in the field" as contemplated by Congress. 
H.R. Rep. No. 101-723, 59 (Sept. 19, 1990); see also section 203(b)(l)(A) of the Act. Moreover, the 
record does not otherwise demonstrate that the Petitioner has garnered national or international 
acclaim in the field, and he is one of the small percentage who has risen to the very top of the field of 
endeavor. See section 203(b)(l)(A) of the Act; 8 C.F.R. § 204.5(h)(2). 
The record does not establish that the Petitioner qualifies for classification as an individual of 
extraordinary ability. The appeal will therefore be dismissed for the above stated reasons, with each 
considered as an independent and alternate basis for the decision. In visa petition proceedings, it is 
the petitioner's burden to establish eligibility for the immigration benefit sought. Section 291 of the 
Act, 8 U.S.C. § l36l;MatterofSkirballCulturalCtr., 25 I&NDec. 799,806 (AAO 2012). Here, that 
burden has not been met." 
ORDER: The appeal is dismissed. 
Cite as Matter of A-T-, ID# 2607377 (AAO Apr. 3, 2019)