dismissed EB-1A Case: Anesthesiology And Critical Care Medicine

U.S. Department of Homeland Security 
20 Mass. Ave.. N.W., Rm. A3042 
Washington, DC 20529 
identifying deleted to 
"vent dearly UQW-~ 
+wasion of w- 
U.S. Citizenship 
and Immigration 
FILE: Office: VERMONT SERVICE CENTER Date: JUN 2 4 2M15 
IN RE: 
PETITION: Immigrant Petition for Alien Worker as an Alien of Extraordinary Ability Pursuant to Section 
203(b)(I)(A) of the Immigration and Nationality Act, 8 U.S.C. 5 1153(b)(l)(A) 
ON BEHALF OF PETITIONER: 
INSTRUCTIONS: 
This is the decision of the Administrative Appeals Office in your case. A11 documents have been returned to 
the office that originally decided your case. Any further inquiry must be made to that office. 
& 
Administrative Appeals Office 
DISCUSSION: The employment-based immigrant visa petition was denied by the Director, Vermont Service 
Center, and is now before the Administrative Appeals Office on appeal. The appeal will be dismissed. 
The petitioner seeks to classify the beneficiary as an employment-based immigrant pursuant to section 
203(b)(l)(A) of the Immigration and Nationality Act (the Act), 8 U.S.C. 8 1153(b)(l)(A), as an alien of 
extraordinary ability in the sciences. The director determined the petitioner had not established that the 
beneficiary has earned the sustained national or international acclaim necessary to qualify for classification as 
an alien of extraordinary ability. 
Section 203(b) of the Act states, in pertinent part, that: 
(1) Priority Workers. -- Visas shall first be made available . . . to qualified immigrants who are aliens 
described in any of the following subparagraphs (A) through (C): 
(A) Aliens with Extraordinary Ability. -- An alien is described in this subparagraph 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 in the area of 
extraordinary ability, and 
(iii) the alien's entry to the United States will substantially benefit prospectively the 
United States. 
As used in this section, the term "extraordinary ability" means a level of expertise indicating that the 
individual is one of that small percentage who have risen to the very top of the field of endeavor. 8 C.F.R. 
9 204.5(h)(2). The specific requirements for supporting documents to establish that an alien has sustained 
national or international acclaim and recognition in his or her field of expertise are set forth in the regulation 
at 8 C.F.R. fj 204.5(h)(3). The relevant criteria will be addressed below. It should be reiterated, however, that 
the petitioner must show that the beneficiary has earned sustained national or international acclaim at the very 
top level. 
This petition, filed on March 28, 2003, seeks to classify the beneficiary as an alien with extraordinary ability 
as a physician specializing in anesthesiology and critical care medicine. At the time of filing, the beneficiary 
was working as a staff physician at The Miriam Hospital in Providence, Rhode Island. 
The regulation at 8 C.F.R. 5 204.5(h)(3) indicates that an alien can establish sustained national or 
international acclaim through evidence of a one-time achievement (that is, a major, international recognized 
award). Barring the alien's receipt of such an award, the regulation outlines ten criteria, at least three of which 
must be satisfied for an alien to establish the sustained acclaim necessary to qualify as an alien of 
extraordinary ability. The petitioner has submitted evidence pertaining to the following criteria. 
Page 3 
Documentation of the alien's receipt of lesser nationally or internationally recognizedprizes or 
awards for excellence in the field of endeavor. 
On appeal, counsel asserts that Delhi University entrance and exit examination test results related to the 
beneficiary's medical studies and training are adequate to satisfy this criterion. According to the beneficiary's 
resume, he "stood 2"* among more than 2,000 medical graduates appearing for an entry examination to post- 
graduate training in internal medicine" conducted by Delhi University in 1986 and "stood 1" among 35 post- 
graduate trainees in Internal Medicine taking the exit examination (Boards)" at Delhi University in 1988. 
Test results from candidates at a particular university, however, do not constitute "nationally or 
internationally recognized prizes or awards for excellence in the field of endeavor." Furthermore, information 
listed on the beneficiary's resume (which represents a claim by the alien rather than evidence) does not meet 
the petitioner's burden of proof. Going on record without supporting documentary evidence is not sufficient 
for purposes of meeting the burden of proof in these proceedings. Matter of Soffii, 22 I&N Dec. 158, 165 
(Comm. 1998) (citing Mutter of Treasure Craft of California, 14 I&N Dec. 190 (Reg. Comm. 1972)). The 
record contains no first-hand evidence of the actual test results to support the claims made in the beneficiary's 
resume. 
In respect to rankings from universities and other learning institutions, Citizenship and Immigration Services 
(CIS) views such results as local or institutional honors rather than nationally or internationally recognized 
prizes or awards for the reason that they are limited to the candidates applying to or graduating from those 
institutions. It is further noted that the individuals taking these examinations were limited to recent medical 
graduates and post-graduate trainees. We cannot artificially restrict the beneficiary's field to exclude all those 
medical professionals who have long since taken their graduate and post-graduate medical examinations. In 
this case, there is no evidence indicating that the beneficiary has received any national or international award 
for which he would have faced competition from throughout his field, rather than his approximate age group 
within that field. 
Documentation of the alien's membership in associations in the field for which classrfication is 
sought, which require outstanding achievements of their members, us judged by recognized 
national or international experts in their disciplines or fields. 
In order to demonstrate that membership in an association meets this criterion, the petitioner must show that 
the association requires outstanding achievement as an essential condition for admission to membership. 
Membership requirements based on employment or activity in a given field, minimum education or 
experience, standardized test scores, grade point average, recommendations by colleagues or current 
members, or payment of dues, do not satisfy this criterion as such requirements do not constitute outstanding 
achievements. Furthermore, the overall prestige of a given association is not determinative; the issue here is 
membership requirements rather than the association's overall reputation. 
The petitioner submitted the beneficiary's medical certifications from the American Board of Anesthesiology, 
the National Board of Echocardiography, the Royal College of Surgeons in Ireland, and the Royal Colleges of 
Physicians in the United Kingdom. Without such certifications, however, the beneficiary would not have 
Page 4 
been permitted to practice medicine in those specialties. We cannot conclude that such certifications, which 
represent standard requirements for entry into a particular medical specialty or profession, are adequate to 
demonstrate "outstanding achievement" in the medical field. We acknowledge the low percentage of board- 
certified anesthesiologists in the United States who also hold a Certificate of Special Competence in Critical 
Care, but the issue here is outstanding membership requirements rather than the number of certifications held. 
The record contains no evidence of the bylaws or the official membership requirements of the above 
organizations to show that they require outstanding achievements of their members. The petitioner has not 
shown that the beneficiary was admitted to membership in these organizations based on his outstanding 
achievement in the medical field rather than his successful completion of a medical examination or training 
program. The record contains no evidence to establish that these organizations require outstanding 
achievements of their members, as judged by recognized national or international experts, in the same manner 
as highly exclusive associations such as (for example) the U.S. National Academy of Sciences. 
Evidence of the ulien's purticipulion, either individuully or on upanel, us u judge of the work of 
others in the sume or un dliedJield of specijcation for which clmsiJicution i.s sought. 
The petitioner submitted a letter from D 
I 
Instructor in Anesthesiology, Harvard Medical 
School, and Staff Anesthesiologist at Harvard s affiliated hospital, Beth Israel Deaconess Medical Center, 
who states: 
~t [the beneficiary] was responsible for training, supervising, and evaluating the work of 
residents and fellows in anesthesiology in the Anesthesia & Critical Care Medicine Program at Harvard. 
He also served as an instructor for the Advanced Trauma and Life Support Course whereby he taught 
surgeons, emergency medicine physicians and paramedics. 
A letter from~nesthesiolo~ist-in-chief, Miriam Anesthesiologists, Inc. (MAI), states: 
"In connection with his current employment at MAI, [the beneficiary's] responsibilities include training and 
judging the work of residents and fellows training in Anesthesia and Critical Care Medicine at Miriam." 
As previously noted, the regulation at 8 C.F.R. 5 204.5(h)(3) provides that "a petition for an alien of 
extraordinary ability must be accompanied by evidence that the alien has sustained national or international 
acclaim and that his or her achievements have been recognized in the field of expertise." Evidence of the 
beneficiary's participation as a judge must be evaluated in terms of these requirements. For example, 
evaluating accomplished physicians as a member on a national panel of experts is of far greater probative value 
than evaluating medical residents in training at one particular hospital. While a course instructor or a 
supervisor of medical residents and fellows in anesthesiology does evaluate the work of his pupils or trainees 
at a particular location, this evaluation process is inherent to serving in such positions. Involvement in such a 
process does not, however, elevate the instructor or supervisor above almost all others in the field at the 
national or international level or demonstrate widespread acclaim. In this instance, the beneficiary's duties 
involved evaluating medical trainees, or those who enrolled in the Advanced Trauma and Life Support 
training course, rather than established professionals in his particular specialty. We find no evidence to 
demonstrate that the beneficiary has formally judged the work of board-certified anesthesiologists or critical 
care physicians who have long since completed their residency or fellowship programs. 
Page 5 
Evidence of the alien's original scientrfic, scholarly, artistic, athletic, or business-related 
contributions of major signzjicance in the$eld. 
The petitioner submitted five letters of support from individuals from  he Hospital and the 
Medical Center. 
While at Harvard, [the beneficiary] did a critical review of blood utilization during cardiac surgery at 
Beth Israel. This led to new protocols in blood product utilization and reduction in bleeding by optimal 
selection drugs to reduce bleeding during cardiac surgery. While a Fellow in Critical Care Medicine at 
Beth Israel, [the beneficiary] started a research project utilizing closed loop feedback control of 
cardiovascular drugs employing a continuous cardiac output catheter and computers to make a 
hemodynamic diagnosis and administer corrective therapy on the fly. In simple terms, this is automatic 
diagnosis of the problem with circulation and its automatic correction by computer driven drug delivery 
pumps in very unstable patients who are in the Intensive Care Unit or the Operating Rooms. This 
technology is truly futuristic and will play a very in years to come. 
Impressed by his vision and ideas, the health care giant onated equipment and grants 
worth $50,000 to [the beneficiary]. 
In particular, [the beneficiary's] research contributions have included development of a new procedure for 
reducing blood loss during cardiac surgery. Specifically,-Jthe beneficiary] developed a cost-effective 
protocol for the drug Aprotinin, called EACA), ,which prevents the 
dissolution of blood clots. As a result of [the beneficiary's] innovative study, mplemented a 
new policy for the use of EACA, as an alternative for patients unable to afford Aprotinin treatments. 
[The beneficiary] also conducted research regarding closed loop feedback control of the cardiovascular 
system using continuous cardiac output catheters, computer controlled infusion devices for 
administration of volume, vasoactive agents and inotropes and digital PID (proportional, integral and 
derivative) controllers. This research lead to the development of a simulator which acquires real-time 
hemodynamic data from bedside monitors in the Operating Room and the ICU. This device delivers 
lifesaving drugs and fluids to patients through computer aided automation, thereby resulting in a more 
efficiently run and safer ICU. 
The record, however, contains no evidence showing that the beneficiary's specific medical innovations are 
widely utilized outside of Beth Israel Deaconess Medical Center or his current employer. Without extensive 
documentation showing that the beneficiary's work is nationally or internationally recognized throughout the 
greater field as a contribution of major significance, we cannot conclude that he fulfills this criterion. 
Page 6 
We note that all of the letters of support were written by individuals from hospitals where the beneficiary has 
worked. This fact indicates that while the beneficiary's work is valued by those close to him, others outside 
his immediate circle are largely unaware of his research and do not attribute the same importance to his work. 
With regard to the personal recommendation of individuals from institutions where the beneficiary has trained 
and worked, the source of the recommendations is a highly relevant consideration. These letters are not first- 
hand evidence that the beneficiary has earned sustained acclaim outside of his affiliated institutions. If the 
beneficiary's reputation is limited to those institutions, then he has not achieved national or international 
acclaim regardless of the expertise of his colleagues. An individual with sustained national or international 
acclaim should be able to produce ample unsolicited materials reflecting that acclaim. 
Evidence of the alien authorshil, of scholarly articles in thejeld, in professional or major trade 
publications or other major media. 
The petitioner submitted evidence of the beneficiary's authorship of a single article entitled "Non-Operating 
Room Emergency Airway Management and Endotracheal Intubation Practices: A Survey of Anesthesiology 
Program Directors" appearing in Anesthesia & Analgesia and the Year Book of Emergency Medicine 1998. 
Regarding this articleletter states: "This article was extensively cited which is an indicator of its 
importance." We concur with-observation that extensive citation by others in one's field is a 
reliable indicator of an article's importance. 
For this reason, we do not find that publication of a scholarly article is presumptive evidence of sustained 
national or international acclaim; we must also consider the greater scientific community's reaction to that 
article. When judging the influence and impact that the beneficiary's work has had, the very act of publication 
is not as reliable a gauge as is the citation history of the published works. Publication alone may serve as 
evidence of originality, but it is difficult to conclude that a published article is important or influential if there 
is little evidence that others have relied upon the beneficiary's findings. Frequent citation by independent 
researchers, however, would demonstrate widespread interest in, and reliance on, the beneficiary's work. If, 
on the other hand, there are few or no citations of an alien's work, suggesting that that work has gone largely 
unnoticed by the greater scientific community, then it is reasonable to conclude that the alien's work is not 
nationally or internationally acclaimed. 
laims that the beneficiary's article was extensively cited, but the record contains no evidence to 
support his assertion. For example, the petitioner has not provided a citation index for the beneficiary's 
article or copies of the numerous articles that cite his findings. Without first-hand evidence showing 
extensive independent citation of the beneficiary's article, we cannot conclude that he fulfills this criterion. 
Evidence that the alien has performed in a leading or critical role for organizations or 
establishments that have u distinguished reputation. 
In order to establish that the beneficiary performed a leading or critical role for an organization or 
establishment with a distinguished reputation, the petitioner must establish the nature of the beneficiary's role 
within the entire organization or establishment and the reputation of the organization or establishment. 
Page 7 
The petitioner submitted a letter from Anesthetist-in-chief, Department of Anesthesia, 
Beth Israel Deaconess Medical Center, and Associate Professor of Anesthesia, Harvard Medical School, stating: 
I am, by this letter, offering you the post of attending faculty in anesthesia . . . for a period of three years 
commencing July 1, 1998. In this post you will be conducting patient care, teaching, and research. This 
carries a concurrent appointment of Instructor in Anesthesia at Harvard Medical School. 
Either you or the department may terminate, without cause, your employment at any time by providing the 
other with 90 days written notice. 
The petitioner also submitted a letter from the Office of the Secretary, Harvard University, dated March 10, 1999, 
reflecting that the beneficiary's Instructor in Anesthesia position was a one-year, temporary appointment. The 
letter notes: "Such terms and conditions include, but are not limited to, the continuing availability of funds from 
sources outside the University. . . ." 
On appeal, counsel asserts that the beneficiary has performed in a leading or critical role for Beth Israel 
Deaconess Medical Center and Harvard Medical School. We concur with the director's observation that these 
establishments enjoy a distinguished reputation, but the evidence of record is not adequate to demonstrate that 
the beneficiary performed in a leading or critical role, particularly since his position at both institutions was a 
temporary appointment. 
The record contains no evidence detailing the extent to which the beneficiary has exercised substantial control 
over personnel or research decisions executed on behalf of the organizations for which he has worked. 
Furthermore, there is no indication that the beneficiary's roles as an attending anesthesiologist at- 
or as a temporary Instructor in Anesthesia at Harvard Medical School were any more important than that of 
the other faculty members serving in the same department as the beneficiary (including tenured professors or 
permanent staff). This criterion, like all of the criteria, is intended to separate the beneficiary from the 
majority of his colleagues in the field. Therefore, when determining the beneficiary's eligibility, it is entirely 
appropriate to compare the beneficiary's role to that of his colleagues. In this case, it is immediately apparent 
that the importance of the role of individuals such asfar exceeds that of the 
beneficiary. For the above reasons, we find that the petitioner's evidence falls short of establishing that the 
beneficiary has performed in a leading or critical role for a distinguished organization, or that his involvement 
has earned him sustained national or international acclaim. 
Evidence that the alien hus communded a high salary or other significantly high rernunerution 
for services, in relation to others in the$eld 
tates: "[The beneficiary] is presently paid a base annual salary of $200,000 by MAI, and is 
eligible for total compensation of approximately $275,000." statement regarding the 
beneficiary's annual compensation is unsupported by objective documentation (such as payroll records or 
income tax forms) showing the beneficiary's actual earnings as of the petition's filing date. Simply going on 
record without supporting documentary evidence is not sufficient for the purpose of meeting the burden of 
proof in these proceedings. See Matter of SofJici at 158, 165. 
The petitioner also submitted evidence from the U.S. Department of Labor showing that the median Level 2 
Wage for anesthesiologists in Rhode Island was $145,350. The petitioner, however, must demonstrate that 
the beneficiary's salary places him at the top of his field at the national level, not simply in the top half at the 
local level. Local prevailing wage figures from the Department of Labor do not meet this standard. We find 
no evidence showing that the beneficiary is among the highest-paid in his field at the national or international 
level. 
Documentation accompanying the petition indicates that the beneficiary in this matter was formerly the 
beneficiary of three approved 0-1 nonimmigrant visa petitions. The approval of an 0-1 nonimmigrant visa 
petition on behalf of a given alien does not in any way compel CIS to approve a subsequent visa petition 
under section 203(b)(l)(A) of the Act on behalf of that same alien. Each petition must be adjudicated on its 
own merits based on the evidence submitted to support that petition. Furthermore, there is no statute, 
regulation, or binding precedent that requires the approval of an immigrant visa petition under section 
203(b)(l)(A) of the Act when the alien already holds an 0-1 nonimmigrant visa. 
The documentation submitted in support of a claim of extraordinary ability must clearly demonstrate that the alien 
has achieved sustained national or intemational acclaim, is one of the small percentage who has risen to the very 
top of the field of endeavor, and that the alien's entry into the United States will substantially benefit 
prospectively the United States. The petitioner in this case has failed to demonstrate the beneficiary's receipt of a 
major internationally recognized award, or that he meets at least three of the criteria that must be satisfied to 
establish the sustained national or international acclaim necessary to qualifL as an alien of extraordinary ability. 
Review of the record does not establish that the beneficiary has distinguished himself to such an extent that he 
may be said to have achieved sustained national or international acclaim or to be within the small percentage at 
the very top of his field. The evidence is not persuasive that the beneficiary's achievements set him significantly 
above almost all others in his field at the national or intemational level. Therefore, the petitioner has not 
established eligibility pursuant to section 203(b)(l)(A) of the Act and the petition may not be approved. 
The burden of proof in visa petition proceedings remains entirely with the petitioner. Section 291 of the Act, 8 
U.S.C. $ 136 1. Here, the petitioner has not sustained that burden. Accordingly, the appeal will be dismissed. 
ORDER: The appeal is dismissed.