dismissed EB-1A Case: Cardiology

U.S. Citizenship 
and Immigration 
Services 
MATTER OF A-M-H 
APPEAL OF TEXAS SERVICE CENTER DECISION 
Non-Precedent Decision of the 
Administrative Appeals Office 
DATE: SEPT. 27. 2017 
PETITION: FORM I-140, IMMIGRANT PETITION FOR ALIEN WORKER 
The Petitioner, a cardiologist, seeks classification as an individual of extraordinary ability in the arts. 
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 Texas Service Center denied the Form I-140. Immigrant Petition for Alien 
Worker, concluding that the Petitioner had satisfied only two of the initial evidentiary criteria. of 
which he must meet at least three. 
On appeal, the Petitioner submits additional evidence and asserts that he satisfies the original 
contributions criterion. 
Upon de novo review. we will dismiss the appeal. 
I. LAW 
Section 203(b)(l)(A) ofthe Act states: 
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 tield 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-M-H-
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 implementing 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). Alternately, he or she must provide evidence that meets at least three 
of the criteria listed at 8 C.F.R. § 204.5(h)(3)(i)-(x) (including items such as awards, published material 
in certain media, and scholarly articles). 
Where a petitioner meets these initial evidence requirements, we then consider the totality of the 
material provided in a final merits determination and assess whether the record 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. US CIS, 596 F .3d 1115 (9th Cir. 201 0) 
(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. USC!S, 772 F. Supp. 2d 1339 
(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 oj'Chawathe, 25 I&N Dec. 369, 376 (AAO 2010). 
II. ANALYSIS 
The Petitioner has indicated he is an interventional cardiologist, claiming major achievements for his 
work on the prevention of post cardiac catheterization contrast induced acute kidney failure and for 
his work on the non-ischemic cardiomyopathy registry. The Director found that the Petitioner met 
the initial evidence requirements for two criteria: judging the work of others and scholarly articles.' 
However, the Director concluded that the record failed to establish that the Petitioner had made 
original contributions of major significance and thus denied the petition without a tina) merits 
analysis. 
On appeal, the Petitioner maintains that the Director failed to consider all of the evidence in the 
record and incorrectly applied a higher standard of proof than the preponderance of the evidence. 
Evidence ofthe alien's participation. either individually or on a panel. as ajudge olthe work ol 
others in the same or an allied.field oj'spec(ficalionfor which class!fication is sought. R C. FR. 
§ 204.5(h)(3)(iv). 
The record contains evidence demonstrating that the Petitioner has been engaged as a reviewer for 
the since 2014. In that capacity, he has reviewed manuscripts 
1 8 C.F.R. § 204.5(h)(3)(iv) and (vi). 
2 
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Matter ofA-M-H-
on topics related to structural heart disease, which is the core focus of interventional cardiology. 
Thus, we agree with the Director that the Petitioner has established that he satisfies this criterion. 
Evidence (~f the alien's authorship (~l scholarly articles in the field. in professional or major 
trade publications or other major media. 
The Director found that the Petitioner satisfied the plain language of this criterion. Upon a review of 
the record, we agree that he has provided evidence of his authorship of scholarly articles that were 
published in professional journals. Specifically, the Petitioner provided evidence of 20 articles 
written and published since 2009, many of which were published in professional or trade 
publications. Accordingly, the Petitioner has satisfied this criterion. 
Evidence ~f the alien ·s original scienf?fic, scholarly. artistic. athletic. or business-related 
contributions ~f major sign(ficance in the field. 
To satisfy this criterion, a petitioner's contributions must be both original and of major significance 
in the field. 8 C.F.R. § 204.5(h)(3)(v). The term "original" and 
the phrase "major significance"' are 
not superfluous and. thus, they have some meaning. Silverman v. Eastrich Multiple Investor Fund. 
L.P., 51 F. 3d 28, 31 (3d Cir. 1995). quoted in APWU v. Potter, 343 F.3d 619,626 (2d Cir. 2003). 
Regardless of the field, the phrase "contributions of major significance in the field" requires 
substantiated impacts beyond one's employer, clients, or customers. 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). 
On appeal, the Petitioner contends that his research on contrast-induced acute kidney injury 
constitutes an original contribution of major significance in the field of interventional cardiology. 2 
In 2012, the Petitioner was the lead author on a paper published in the journal 
that discussed a trial of 320 cardiac catheterization patients with kidney 
issues. The patients received a hydration therapy including either normal saline or sodium 
bicarbonate, with half of each group further also receiving N-acetylcysteine. The study concluded 
that the incidence of patients demonstrating contrast induced acute kidney injury was even between 
the two hydration therapies, and that the administration of N-acetylcysteine did not reduce the 
incidence of acute kidney injury in either hydration therapy. 
The a professional organization 
focused on cardiac catheterization and related laboratory procedures, publishes the journal. In 2012, 
published a consensus statement on best practices for cardiac catheterization laboratories. 3 
2 
Initially, the Petitioner claimed to have satisfied this criterion based on his work in three separate areas: his heart attack 
research, his work on the non-ischemic cardiomyopathy register, and his research on contrast induced acute kidney 
injury. On appeal, the Petitioner did not submit any evidence or raise concerns regarding the other two grounds, so we 
will not review them. 
·' 
3 
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Matter of A-M-H-
The clinical experts who drafted the statement cite to the Petitioner's paper in the section on pre­
procedural checklists, where they recommend that providers should strongly consider either saline of 
sodium bicarbonate hydration for patients with baseline renal insufficiency, unless contraindicated 
by congestive heart failure. They further indicated that recent data suggests that N-acetylcysteinc 
does not provide significant benefit and no longer recommend its routine use for patients with 
baseline renal insufficiency. In 2016, issued a second expert consensus statement and once 
again cited to the Petitioner's work with similar language. 4 
Much of the Petitioner's claim to have made an original contribution of major significance comes 
from the reference to his research in the consensus statement. In his appellate brief he 
contends that the consensus statements "do not simply cite to his work, but list [his] above findings 
as the best practice in these cases." The Petitioner maintains that the consensus statements are 
considered the standard of care to be followed for all cardiac catheterization laboratories, 
emphasizing the significance of his research. 
The Petitioner equates references to the consensus statement of best practices regarding 
contrast-induced acute kidney injury as citations directly to his research. We disagree, finding that 
the record does not support the Petitioner's contention. The introduction to the 2012 consensus 
statement explains that many of the recommendations contained in the document are based on the 
expert opinions of the authors and that references would be provided, if available. Relevantly, while 
the authors cite to the Petitioner's findings on the two hydration therapies, the guidance in the 
consensus statement goes beyond his research. The authors, citing no other research, restrict their 
recommendation to those patients who are not contraindicated by congestive heart failure. The 
record does not demonstrate that the Petitioner's paper addresses additional concerns for patients 
with congestive heart failure. 5 In the same section, when discussing the effectiveness of N­
acetylcysteine, the authors cite to the Petitioner's research and an unassociated work. As authors of 
the 2012 consensus statement independently expand on the Petitioner's findings and cite to 
additional research, the best practices contained therein distinguish themselves from the Petitioner's 
paper and two cannot be considered synonymous. 
The 2016 consensus statement similarly differentiates the authors· recommended best 
practices from the Petitioner's research. The authors cite his research twice in a section on chronic 
kidney disease. referencing multiple other sources both times. The first reference notes that the only 
strategies consistently shown to reduce kidney injury are hydration and minimizing the contrast 
dose. While the Petitioner's paper is cited, the text of the consensus statement credits guidelines 
(2012). 
(20 16) 
o The record contains only the title page of the Petitioner's paper, which provides only a brief abstract of the research and 
findings. 
4 
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Matter C?f A-M-H-
jointly issued by the and the 
in 2011, a year before the Petitioner's paper was published. The authors also cited the 
Petitioner and two other sources when discussing the efTectiveness of N-acetylcysteine.
6 
As the 
2016 consensus statement never cites solely to the Petitioner's work, the record does not suppot1 the 
Petitioner's contention that references to the best practices contained therein are referring to his 
research. 
The Petitioner provides a number of testimonial letters from other interventional cardiologists in 
support of the value of his work on contrast induced acute kidney injury. Several of these address 
the importance of the consensus statement as they relate to procedures in the cardiac 
catheterization laboratory. The Petitioner contends that any 
reference to the consensus 
statement relate specifically to his findings, even if the letter does not reference the Petitioner or his 
research. We are not persuaded as the consensus statements, even in the sections dealing 
specifically with contrast induced acute kidney injury, contain guidance beyond the scope of the 
Petitioner's research. 
The letters that do specifically reference 
the Petitioner or his research are insufficient to establish 
that he has made original contributions of major significance in the field. The record contains a 
letter from director of the at 
stating that the consensus statement and the Petitioner's paper on 
contrast induced acute kidney injury are "very relevant" to his practice. does not indicate 
what impact the Petitioner's research has had on the field or that his findings are of major 
significance. 
Similarly, a professor of medicine at the states that 
he finds the Petitioner's paper and 
the consensus statement to be '·important" publications on 
the implementation of best practices and his understanding of the national standard of care and 
ongoing research interests. letter does not substantiate the impact that the 
Petitioner's contributions have had on his own practice or demonstrate that they have been of major 
significance to the field. 
Chief of Medicine for the writes about the 
impact of the consensus statement, noting that both the 2012 and 2016 guidelines reference the 
Petitioner's work. further states that he considers the Petitioner's paper to be an important 
source of evidence for developing guidelines for the best practices for the operation of cardiac 
catheterization laboratories. While acknowledging that the Petitioner's research affected the field 
through its use as supporting evidence in the development of best practices, letter does 
not indicate that the Petitioner's research has had substantiated impacts and has been a contribution 
of major significance. 
6 
Of note, both other sources cited predate the publication ofthe Petitioner's research. 
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Matter of A-M-H-
The record contains a letter from one of the senior writers on the consensus 
statement, indicating that he reviewed hundreds of publications on the subject of the Petitioner's 
research, contrast induced kidney injury. notes that the Petitioner's research was 
one of three papers on the topic that the writers thought worthy of citation, but provides no 
explanation of what made the Petitioner's work more meritorious than the hundreds of other 
publications on the same topic. Most importantly , Jetter does not explain how the 
Petitioner's paper has had an impact on the field in general or that it is a contribution of major 
significance. 
Furthermore, the record does not establish that citation of the Petitioner's work by and others 
in his field makes his research a contribution of major significance. The Petitioner states that his 
2012 article has been cited 28 times, which he claims is three times the average citation rate for the 
journal in which it was published. However, the Petitioner does not explain how he arrived at his 
conclusion that the article has been cited three times more than an average article from the journal 
and provides no evidence supporting this claim. 7 Furthermore, he has not demonstrated that the 
level of citation identified is commensurate with an original contribution of major significance in the 
field of interventional cardiology. 
Tangentially, the Petitioner has submitted evidence to demonstrate the importance of 
consensus statements within the field of interventional cardiology. Some of the documentation 
relates to accreditation programs for cardiac catheterization laboratories through entities like the 
or the 
Additionally, many of the testimonial letters highlight the importance of and its consensus 
statements. While the evidence submitted may suffice to establish the status of within the 
field, it is insufficient to demonstrate that the citation to the Petitioner's paper in the consensus 
statement makes his research a contribution of major significance in the tiel d. 
The Petitioner provided documents related to the 
He claims credit for certain best practice 
protocols identified in the documents, pointing to the similarities to his research. However, the 
documents do not reference him, his research , or the consensus statements citing his work. 
Without a link to the Petitioner , the documents do not substantiate the impact of his work or 
establish that his contribution is of major significance. 
7 
Contextually, the Petitioner appears to multiply the journal's impact factor by the number of years that have passed 
since publication to calculate the theoretical average number of citations for an article in the journal. The impact factor 
attempts to quantify a journal 's prestige and influence on a field of study and is derived by dividing the total number of 
citations to a journal over the previous two whole years by the total number of citable documents in the journal over the 
same time period . The limited range of data considered in determining the impact factor prevents it from being an 
accurate portrayal of average citations over the life of a document , as the Petitioner is using it. For a discussion of how 
the ultimate source of the Petitioner ' s information , calculates impact factor s for its 
see http:/, 
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Matter of A-M-H-
The Petitioner also indicates that his work was cited in a chapter of the edition of the 
A letter from the publisher indicates that the textbook is one 
of two core references for the interventional cardiology specialty. The only reference to the 
Petitioner's research in the chapter occurs when author notes that recent clinical trials have not 
demonstrated any significant ditTerence between sodium bicarbonate and sodium chloride hydration 
therapies, for which the author cites to the Petitioner and four other sources . The evidence in the 
record does not demonstrate that the citation to the Petitioner's research has had an impact of major 
significance on the field. 
Finally, the Petitioner contends on appeal that the record of his achievements must be considered as 
a whole, rather than piecemeal, in determining whether he meets the eligibility requirements. In 
considering the totality of the evidence before us, the Petitioner demonstrates that he has made an 
original contribution to the field of interventional cardiology, but has failed to substantiate impacts 
on the field at large that would demonstrate his contribution has been of major significance. 
Accordingly , the Petitioner has not established that he satisfies the plain language of this criterion . 
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, we advise 
that we have reviewed the record in the aggregate, concluding that it does not support a finding that 
the Petitioner has established the level of expertise required for the classification sought. For the 
foregoing reasons, the Petitioner has not shown that he qualities for classification as an individual of 
extraordinary ability. 
ORDER: The appeal is dismissed. 
Cite as Matter (~/A-M-H-, ID# 537165 (AAO Sept. 27, 2017)