dismissed EB-1A Case: Medicine

i-tifying data deleted to 
grevent clearly unwarranted 
invasion of personal privmy 
PUBLIC COPY 
U.S. Department of Homeland Security 
U.S. Citizenship and Immigration Services 
Of$ce of Administrative Appeals, MS 2090 
Washington, DC 20529-2090 
U. S. Citizenship 
and Immigration 
SRC 07 234 5 1462 
IN RE: 
PETITION: 
 Immigrant Petition for Alien Worker as an Alien of Extraordinary Ability Pursuant to 
Section 203(b)(l)(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. All documents have been returned to 
the office that originally decided your case. Any further inquiry must be made to that office. 
If you believe the law was inappropriately applied or you have additional information that you wish to have 
considered, you may file a motion to reconsider or a motion to reopen. Please refer to 8 C.F.R. 5 103.5 for 
the specific requirements. All motions must be submitted to the office that originally decided your case by 
filing a Form I-290B, Notice of Appeal or Motion, with a fee of $585. Any motion must be filed within 30 
days of the decision that the motion seeks to reconsider or reopen, as required by 8 C.F.R. 5 103.5(a)(l)(i). 
w chief, Administrative Appeals Office 
DISCUSSION: The Director, Nebraska Service Center, denied the employment-based immigrant visa 
petition, which is now before the Administrative Appeals Office (AAO) on appeal. The appeal will be 
dismissed. 
The petitioner seeks classification as an "alien of extraordinary ability" in the sciences, pursuant to 
section 203(b)(l)(A) of the Immigration and Nationality Act (the Act), 8 U.S.C. 5 1 153(b)(l)(A). The 
director determined the petitioner had not established the sustained national or international acclaim 
necessary to qualiQ for classification as an alien of extraordinary ability. 
On appeal, counsel submits a brief. For the reasons discussed below, while the director did not 
explicitly address all of the regulatory criteria claimed by the petitioner, we uphold the director's 
ultimate conclusion that the petitioner has not established his eligibility for the exclusive classification 
sought. 
The AAO maintains plenary power to review each appeal on a de novo basis. 5 U.S.C. 5 557(b) ("On 
appeal from or review of the initial decision, the agency has all the powers which it would have in 
making the initial decision except as it may limit the issues on notice or by rule."); see also Janh v. 
US. Dept. of Transp., NTSB, 925 F.2d 1 147, 1 149 (9th Cir. 1991). The AAO's de novo authority has 
been long recognized by the federal courts. See, e.g., Dor v. INS, 891 F.2d 997, 1002 n. 9 (2d Cir. 
1989). 
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 into the United States will substantially benefit 
prospectively the United States. 
U.S. Citizenship and Immigration Services (USCIS) and legacy Immigration and Naturalization Service 
(INS) have consistently recognized that Congress intended to set a very high standard for individuals 
seeking immigrant visas as aliens of extraordinary ability. See 56 Fed. Reg. 60897, 60898-9 (Nov. 29, 
1991). 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. 5 204.5(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. 5 204.5(h)(3). The relevant criteria will be addressed below. 
It should be reiterated, however, that the petitioner must show that he has sustained national or 
international acclaim at the very top level. 
This petition seeks to classify the petitioner as an alien with extraordinary ability as a physician. 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, internationally 
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 that, he claims, meets the 
following criteria under 8 C.F.R. 5 204.5(h)(3).' 
Documentation of the alien's receipt of lesser nationally or internationally recognized prizes or 
awards for excellence in the Jield of endeavor. 
Prior counsel initially asserted that the petitioner "has been the recipient of numerous national awards 
and distinctions throughout his career." Prior counsel then references the petitioner's job positions and 
travel awards. The petitioner submitted evidence that he received travel scholarships to attend to 
Fellows Conferences sponsored by the American College of Chest Physicians (ACCP). One letter 
references the petitioner's selection by his "training director," revealing that fellows are still in training. 
An electronic mail message references the courses provided at the conference, suggesting they are 
primarily training conferences. 
Regarding any awards won by the petitioner, the director requested evidence of the geographic range 
for the pool of candidates and evidence of the scope and media coverage of the award. In response, 
prior counsel referenced what she conceded are more "distinctions than actual awards," such as the 
petitioner's job positions and quotes from the petitioner in the media. Finally, prior counsel reiterated 
that the petitioner has received travel awards. 
In support of prior counsel's assertions, the petitioner submitted a letter from 
 an 
assistant professor at the University of Massachusetts, who evaluates the petitioner's achievements 
based on a review of the petitioner's curriculum vitae. 
 petitioner's academic 
awards and then addresses the petitioner's career. 
 notes "with great interest" 
- 
that the petitioner was interviewed in Health News Daily and states that only the "top given experts in 
the medical field" are interviewed in this publication. further states that "only those who 
have greatly distinguished themselves are selected for a role at" the Albert Einstein College of 
1 
 The petitioner does not claim to meet or submit evidence relating to the criteria not discussed in this 
decision. 
Medicine where the petitioner works. then discusses the etitioner's memberships and, 
"much more impressive," the petitioner's publications. Finally, & discusses the petitioner's 
research on pleural effusion and the petitioner's conference presentation on this subject. - 
does not explicitly equate any of the petitioner's "distinctions" to awards or prizes. 
The director concluded that the petitioner's academic awards could not be considered lesser nationally 
or internationally recognized awards or prizes for excellence in the field. On appeal, counsel does not 
specifically address this criterion. 
We concur with the director that academic awards cannot serve to meet this criterion. Competition for 
scholarships and academic awards is limited to other students. Experienced experts in the field are 
not seeking scholarships or academic awards. Similarly, experienced experts do not compete for 
travel awards to attend training courses, fellowships or competitive training positions such as 
internships or residencies. Thus, they cannot establish that a petitioner is one of the very few at the 
top of his field. 
We note that the regulations include separate criteria for published material about the alien and 
leading or critical roles. 8 C.F.R. $5 204.5(h)(3)(iii), (viii). Such accomplishments are not awards 
or prizes. Moreover, the petitioner has not established that this criterion is not readily applicable to 
the medical field. Thus, we need not consider whether job titles or coverage in the media is 
comparable evidence pursuant to 8 C.F.R. 5 204.5(h)(4). Regardless, we are not persuaded that 
evidence related to but insufficient to meet the criteria at 8 C.F.R. $5 204.5(h)(3)(iii) and (viii12 must 
be considered comparable to qualifying awards or prizes pursuant to 8 C.F.R. 5 204.5(h)(3)(i). 
In light of the above, the petitioner has not established that he meets this criterion. 
Documentation of the alien's membership in associations in the field for which classlJication is 
sought, which require outstanding achievements of their members, as judged by recognized national 
or international experts in their disciplines orjields. 
Prior counsel initially asserted that the petitioner meets this criterion through his board certifications 
and other memberships that require exceptional ability and significant contributions to the field. The 
petitioner submitted evidence of his certifications, memberships and materials about the entities 
through which he has obtained certification or membership. The record reflects that the petitioner was 
certified in Internal Medicine from the American Board of Internal Medicine (ABIM) and evidence that 
ABIM certifies physicians who demonstrate an ability and commitment to quality medical care based 
on an examination. Similarly, the petitioner is certified by the American Board of Medical Specialties 
(ABMS), which requires a physician to demonstrate, through testing and peer evaluation, the 
knowledge, experience and skills for providing quality healthcare in a specialty. The materials for 
2 
 For the reasons discussed below, the evidence submitted to meet the criteria set forth at 8 C.F.R. 
$5 204.5(h)(3)(iii) and (viii) is insufficient. 
ABMS submitted by the petitioner tout certification as being significant for physicians "preparing for" a 
career in teaching, research or practice restricted to that specialty. 
The petitioner also submitted evidence of his affiliate membership in ACCP, which has 16,000 active 
members and requires only completion of medical education, board certification and an interest in 
cardiopulmonary medicine or a related specialty. In addition, the petitioner submitted evidence of his 
membership in the American Medical Association (AMA), the largest physicians group in the United 
States. The petitioner also documented his membership in the Society of Critical Care Medicine 
(SCCM), which has 13,000 members including non-physicians. The petitioner participated as a fellows 
presenter at the Laennec Society of Philadelphia which has 350 members within the Delaware Valley. 
This appears to be a local society. The petitioner is also an associate member of the American College 
of Physicians (ACP), which is the nation's largest medical specialty society with 120,000 members in 
seven categories from student to fellow. In addition, the petitioner is a member of the American 
Thoracic Society (ATS) which has 14,573 members and lists no membership requirements in the 
materials submitted into the record. Finally, the petitioner is a member of the Association of Physicians 
of Pakistani Descent in North America (APPNA), which requires a valid physician's license, 
engagement in academic teaching, research or administration or enrollment in postgraduate training. 
The director requested evidence that the petitioner was a member of an association that requires 
outstanding achievements of its members, including proof of membership and the actual membership 
requirements. In response, prior counsel asserted that very few societies within the medical field 
require outstanding achievements for membership and, thus, requested that the director consider the 
favorable opinions of the petitioner's peers as comparable evidence to meet this criterion. 
The director concluded that the esteem of one's colleagues could not be understood as a membership in 
a qualifying association. Counsel does not challenge this conclusion on appeal. 
We concur with the director that the petitioner has not established that he meets this criterion. The 
petitioner's board certifications are exam-based to confirm competency in a specialty. They are not 
memberships that require outstanding achievements. The petitioner's professional memberships, some 
of which are at only the affiliate or associate level, are within large (and thus non-exclusive) 
associations that require only the necessary credentials to practice in the profession. These 
memberships cannot be considered qualifiing. 
Prior counsel asserted in response to the director's request for additional evidence that few societies in 
the medical field require outstanding achievements. Even if true, the existence of only a few qualifiing 
societies does not suggest that this criterion is inapplicable in the petitioner's field. Prior counsel did 
not suggest that there is no qualifiing society and the petitioner submitted evidence that ACP has a 
membership level of invited  fellow^.^ Rather than a reason to find this criterion inapplicable, the 
3 
 As the petitioner is not a fellow of ACP, we need not address whether ACP fellowship is qualifying. 
Rather, we simply note that there are memberships in the field far higher than those attained by the petitioner. 
We further note the existence of the Institute of Medicine of the National Academies which, according to 
limited number of qualifling societies is precisely why evidence of membership in such a society is 
indicative of or consistent with national or international acclaim. The fact that it is not easy to meet this 
criterion does not imply that USCIS should accept lesser evidence; the regulatory criteria were not 
designed to be easily met by the majority of professionals. 
As acknowledged above, the regulation at 8 C.F.R. § 204.5(h)(4) permits the submission of 
"comparable" evidence where the regulatory criteria set forth at 8 C.F.R. 3 204.5(h)(3) are not "readily 
applicable." We reiterate that the existence of a limited number of qualifiing societies does not suggest 
that this criterion is inapplicable. Rather, the criteria were designed to demonstrate that an alien is one 
of the small percentage at the top of the field. Thus, they were not designed to be easily met. As the 
petitioner has not demonstrated that ths criterion is inapplicable to the medical profession, we need not 
consider "comparable evidence" to meet it. 8 C.F.R. 5 204.5(h)(4). Regardless, the favorable opinions 
of a selection of the petitioner's peers are not comparable to formal admittance to an association that 
limits membership to those able to demonstrate outstanding achievements as judged by national or 
international experts in the field. 
In light of the above, the petitioner has not established that he meets this criterion through the 
submission of the evidence mandated under 8 C.F.R. 5 204.5(h)(3)(ii) or comparable evidence pursuant 
to 8 C.F.R. $204.5(h)(4). 
Published material about the alien in professional or major trade publications or other major 
media, relating to the alien's work in the field for which class2Jication is sought. Such evidence 
shall include the title, date, and author of the material, and any necessary translation. 
Prior counsel initially stated: "It is not surprising for someone of [the petitioner's] stature to have his 
name appear in numerous prestigious directories." Specifically, prior counsel referenced the directory 
of the American Board of Medical Specialists (ABMS) and Strathmore's Who's Who. Finally, prior 
counsel stated that the petitioner's name "has also appeared frequently in the popular media." 
The petitioner submitted an article in Health News Daily, a daily news service from "FDC Reports" 
reporting that infliximab shows promise in effectively and safely treating refractory multisystem 
sarcoidosi, an off-label use of the medication. The article begins by discussing the petitioner's 
presentation at the annual meeting of ACCP in which he reported the results of his study of infliximab. 
The article then notes that audience members "with expertise in using infliximab for refractory 
sarcoidosis confirmed [the petitioner's] impression that when patients are refractional to conventional 
therapies, they are generally refi-actory at sites other than the lung." According to this article, the same 
panel went on to debate the value of prescribing methotrexate with infliximab. The article concludes 
kith a lengthy discussion of view on this issue, noting the session chair's 
statement: "When an insurance company wants to know [where] the data [are] that infliximab works, 
you can point to study." (Brackets in original.) The article is reprinted from Elsevier 
their website at http://www.iom.edu/ (accessed October 15, 2009 and incorporated into the record of 
proceeding) has a membership of approximately 1,700. 
Global Medical News. This article was also reprinted on FDC Report's website as well as other 
websites of undocumented significance. 
In addition, the petitioner submitted an edition of The White Coat, a resident newsletter for the Albert 
Einstein Healthcare Network. The newsletter, under "Einstein Happenings," reports that the petitioner 
addressed a symposium on the role of infliximab in refractory sarcoidosis at ACCP's annual meeting. 
Similarly, the Drexel Newspaper, a newsletter for Drexel University, notes that in addition to other 
presenters from Drexel University, the petitioner, a former resident at Drexel, presented his research at 
an ACCP annual meeting. 
The petitioner also submitted evidence that Strathmore's Who's Who: Registry of Outstanding 
Professionals includes a listing for the petitioner for which he received a plaque. The petitioner 
submitted promotional materials about Strathrnore's from its website. While the materials suggest that 
individuals are selected based on leadership and achievements, they also indicate that the registry 
includes thousands of entries and that individuals can self-nominate themselves. There is no indication 
that the plaques are awarded without fee in recognition of achievements rather than being offered for 
purchase by this for-profit company. 
The director requested evidence of the circulation of the publications in which the petitioner has been 
covered. In response, prior counsel continued to assert that the etitioner meets this criterion but did 
not address this criterion in depth. As stated above, hexpresses his "great interest that [the 
petitioner] was interviewed in a published interview for Health News Daily, a daily news service from 
FDC reports." further asserts that only "the top given experts in the medical field are 
selected for interviews by the FDC." A review of the article, however, reveals that while the 
petitioner's statements are paraphrased in the article, it is not an interview with the etitioner. Rather, 
the article reports on the symposium where the petitioner presented his study. a concludes 
that FDC reports help pharmaceutical and healthcare executives, policymakers and analysts to better 
understand the current developments affecting the regulation of healthcare products in the United States 
and allowed the petitioner "to reach not only fellow physicians" but also "lay members of the medical 
field who play a role in the development of new drugs and therapies used to treat various conditions." 
The director did not explicitly address this criterion or acknowledge the evidence discussed above. 
Counsel also fails to address this criterion on appeal. Given the submission of the above evidence, 
however, we find that this criterion warrants some discussion. 
The regulation at 8 C.F.R. 5 204.5(h)(3)(iii) requires evidence of published material "about" the 
petitioner relating to his work. The article in FDC Reports, reproduced at other sites, is not "about" the 
petitioner. It is about a symposium where he presented the results of a study in which he participated 
while a resident at Drexel University. Moreover, the article also discusses the reaction of other 
physicians also using the U.S. Federal Dnig Administration (FDA) approved drug for the sme off- 
label purpose and the presentation of a published study by a different physician. While we 
acknowledge the statement of regarding the usefulness of FDC Reports and the 
significance of being interviewed for this publication, the petitioner's presentation was merely 
paraphrased in this publication, which also covered a separate study by another research team. 
Moreover, the record includes little information regarding selection for inclusion in FDC Reports. For 
example, if all studies examining the risks and benefits of an off-label use of an FDA-approved drug 
are covered in this newsletter, the inclusion of the petitioner's study does not set him apart from other 
clinical researchers investigating off label uses of FDA-approved drugs. Ultimately, however, as the 
FDC Reports article is not "about" the petitioner relating to his work, it cannot serve to meet this 
criterion. 
In addition, inclusion in internal institutional newsletters is not indicative of or consistent with national 
or international acclaim. The record contains no evidence that these newsletters are nationally 
distributed or otherwise have a circulation consistent with a professional or major trade journal or other 
major media. Thus, coverage in the internal newsletters where the petitioner has worked and trained 
cannot serve to meet this criterion. Finally, we are not persuaded that inclusion as one of thousands of 
professionals in a vanity-press type directory published by a for-profit company intent on selling 
directories and plaques can serve to meet this criterion. 
In light of the above, the petitioner has not demonstrated that he meets this criterion. 
Evidence of the alien's participation, either individually or on a panel, as a judge of the work of 
others in the same or an alliedfield of speclJication for which classfication is sought. 
Prior counsel initially asserted that the petitioner meets this criterion based on his supervision of junior 
physicians, fellows, medical students and interns. In addition, prior counsel asserted that the petitioner 
"regularly lectures to colleagues on some of the most important clinical issues and practices related to 
the field of critical care" and has led journal clubs and "grand rounds," which "inherently involves 
judging the work of leading physicians from around the world." Finally, prior counsel references the 
petitioner's work as a peer reviewer. 
The petitioner's self-prepared curriculum vitae states that he is an "Elsevier Resident Advisory Board 
member" and, in this position, reviews articles and provides valuable feedback to the advisory board. 
He also notes his participation in Grand Rounds that reviews interesting and challenging cases and a 
monthly journal club that reviews the latest articles. These duties appear limited to the institutions 
where he works. Under the pink sheet labeled "Judge of the Work of Others," the petitioner submitted 
only a review manuscript by the petitioner that was currently under review for publication in Thorax. 
Under the pink sheet labeled "Leading and Critical Roles," the petitioner submitted a self-serving list of 
his responsibilities at various institutions, internet materials about those institutions and Procedural 
Skill Documentation forms signed by the petitioner as the supervising physician. Under the pink sheet 
labeled "Awards and Distinctions," the petitioner included a subsection with a letter inviting the 
petitioner to attend a professional and cultural program in Vietnam and Cambodia certified as 
qualifjing continuing medical education. The petitioner also included as part of this subsection a letter 
addressed to the petitioner as a randomly selected member of the American Thoracic Society's Critical 
Care Assembly inviting the petitioner to comment on specific clinical situations. No other evidence is 
labeled as relating to this criterion and despite our review of all of the voluminous evidence submitted: 
we were unable to discover other evidence relating to this criterion. 
The director requested documentary evidence to support this criterion. 
 Noting the voluminous 
materials submitted, the director requested that all evidence be organized and labeled as to which 
criteria it supported. In response, prior counsel asserted that because the petitioner has mastered 
advanced procedures that few others perform, he is "constantly called upon to teach and evaluate the 
performance of advanced procedures." Prior counsel further asserted that the petitioner served as a 
reviewer for a major pulmonary journal and referenced the original evidence submitted. 
The director concluded that performing and teaching procedures and peer review cannot serve to meet 
this criterion. On appeal, counsel reiterates that the petitioner reviewed manuscripts prior to 
publication and asserts that the director disregarded this evidence as well as testimony regarding the 
significance of these requests. 
We acknowledge the prior assertions of both prior counsel and current counsel that the petitioner has 
reviewed manuscripts for publications and the petitioner's own self-serving statements on his 
curriculum vitae. 
 The unsupported assertions of counsel do not constitute evidence. Matter of 
Obaigbena, 19 I&N Dec. 533, 534 n.2 (BIA 1988); Matter of Laureano, 19 I&N Dec. 1, 3 n.2 (BIA 
1983); Matter of Ramirez-Sanchez, 17 I&N Dec. 503, 506 (BIA 1980). Similarly, going on record 
without supporting documentary evidence is not sufficient for purposes of meeting the burden of proof 
in these proceedings. Matter of Sofici, 22 I&N Dec. 158, 165 (Cornm'r. 1998) (citing Matter of 
Treasure Craft of California, 14 I&N Dec. 190 (Reg'l. Cornm'r. 1972)). While we acknowledge that 
the record contains voluminous materials, we were unable to locate confirmation of the petitioner's role 
as a peer reviewer or attestations of the significance of peer review. 
Even assuming the petitioner has performed peer review, we are not persuaded that such peer review 
would serve to meet this criterion. The evidence submitted to meet this criterion, or any criterion, must 
be indicative of or consistent with sustained national or international acclaim. Accord Yasar v. DHS, 
2006 WL 778623 *9 (S.D. Tex. March 24,2006); All Pro Cleaning Services v. DOL et al., 2005 WL 
4045866 * 11 (S.D. Tex. Aug. 26, 2005). We cannot ignore that scientific journals are peer reviewed 
and rely on many scientists to review submitted articles. Thus, peer review is routine in the field and, 
by itself, is not indicative of or consistent with sustained national or international acclaim. The 
petitioner must submit evidence that sets him apart from others in his field, such as evidence that he has 
reviewed manuscripts for a journal that credits a small, elite group of referees, received independent 
requests from a substantial number of journals, or served in an editorial position for a distinguished 
journal. 
A notable amount of the documentation, for example the significant amount of documentation relating to a 
shortage of doctors, is not relevant to the issue of whether the petitioner enjoys sustained national or 
international acclaim. 
Regarding the other claims under this criterion, internal review of student work is not indicative of or 
consistent with national or international acclaim and, thus, cannot serve to meet this criterion. 
Kazarian v. USCIS, - F. 3d -, 2009 WL 2836453, "5 (9th Cir. 2009). Similarly, we are not 
persuaded that participation in the normal practice of sharing unusual cases within one's institution or 
an internal journal club is indicative of or consistent with national or international acclaim. 
In light of the above, even if the petitioner had documented his claimed judging experience, we could 
not conclude that the petitioner meets this criterion. 
Evidence of the alien's original scientiJic, scholarly, artistic, athletic, or business-related 
contributions of major signiJicance in the field. 
Prior counsel relied on letters from the petitioner's colleagues as evidence that the petitioner has made 
both clinical and research contributions of major significance. The director requested more specific 
examples of how the petitioner had impacted the field. In response, the petitioner submitted additional 
letters characterized by prior counsel as establishing that the petitioner's work has been practical, 
important and has improved the abilities of other members of the field. The director concluded that 
while the petitioner had established the importance of his work to his employer, he had not established 
that his work constituted an original contribution of major significance. On appeal, counsel 
characterizes the petitioner as pioneering with a reputation as a remarkable physician who has 
accomplished numerous outstanding achievements. Counsel does not, however, specifically address 
this criterion. 
We do not contest that the petitioner, as a clinical researcher, has published or presented original 
case studies and other original research results that have added to the general pool of knowledge in 
the field. According to the regulation at 8 C.F.R. 5 204.5(h)(3)(v), however, an alien's contributions 
must be not only original but of major significance. We must presume that the phrase "major 
significance" is not superfluous and, thus, that it has some meaning. To be considered a contribution 
of major significance in the field of science, it can be expected that the results would have already 
been reproduced and confirmed by other experts and applied in their work. Otherwise, it is difficult 
to gauge the impact of the petitioner's work. 
Moreover, the regulations contain a separate criterion regarding the authorship of published articles. 
8 C.F.R. § 204.5(h)(3)(vi). We will not presume that evidence relating to or even meeting the scholarly 
articles criterion is presumptive evidence that the petitioner also meets this criterion. To hold otherwise 
would render meaningless the statutory requirement for extensive evidence or the regulatory 
requirement that a petitioner meet at least three separate criteria. See also Kazarian v. USCIS, F. 3d 
- , 2009 WL 2836453, *6 (9Lh Cir. 2009) (publications and presentations are insufficient under this 
criterion, 8 C.F.R. $204.5(h)(3)(v), absent evidence that they constitute contributions of major 
significance). 
We will consider the petitioner's reference letters below. The opinions of experts in the field, 
however, while not without weight, cannot form the cornerstone of a successful claim of sustained 
national or international acclaim. USCIS may, in its discretion, use as advisory opinions statements 
submitted as expert testimony. See Matter of Caron International, 19 I&N Dec. 791, 795 (Comm'r. 
1988). However, USCIS is ultimately responsible for making the final determination regarding an 
alien's eligibility for the benefit sought. Id. The submission of letters from experts supporting the 
petition is not presumptive evidence of eligibility; USCIS may evaluate the content of those letters as 
to whether they support the alien's eligibility. See id. at 795. USCIS may even give less weight to an 
opinion that is not corroborated, in accord with other information, or is in any way questionable. Id. 
at 795; see also Matter of SofJici, 22 I&N Dec. 158, 165 (Comm'r. 1998) (citing Matter of Treasure 
Craft of California, 14 I&N Dec. 190 (Reg'l. Cornm'r. 1972)). 
In evaluating the reference letters, we note that letters containing mere assertions of widespread 
acclaim and vague claims of contributions are less persuasive than letters that specifically identify 
contributions and provide specific examples of how those contributions have influenced the field. 
In addition, letters from independent references who were previously aware of the petitioner through 
his/*her reputation and who have applied his work are far more persuasive than letters from 
independent references who were not previously aware of the petitioner and are merely responding to 
a solicitation to review the petitioner's curriculum vitae and work and provide an opinion based 
solely on this review. Ultimately, evidence in existence prior to the preparation of the petition 
carries greater weight than new materials prepared especially for submission with the petition. An 
individual with sustained national or international acclaim should be able to produce unsolicited 
materials reflecting that acclaim. Vague, solicited letters from local colleagues or letters that do not 
specifically identify contributions or how those contributions have influenced the field are 
insufficient. Kazarian, 2009 WL 2836453 at "5. 
The petitioner obtained his medical degree at the Khyber Medical College in Pakistan and performed 
postgraduate training at that institution's hospital and the Lady Reading Hospital in Pakistan. In 2003, 
the petitioner joined the staff of Drexel University in Philadelphia and in 2006 he joined the staff of the 
Albert Einstein Medical Center in Philadelphia where he remained as of the date of filing. 
- a supervising and consulting physician at Khyber Medical College, confirms 
that the petitioner served as a clinical student and, subsequently, a senior House Physician in - 
unit, all within a residency capacity. 
 praises the petitioner's clinical knowledge and skills but 
does not identify any specific contributions that have impacted the field. Other physicians at this 
institution provide similar letters. a professor at Khyber Medical College, adds 
that the petitioner was part of the epidemiological survey team that visited different areas of the 
province and presented the results of a survey and participated in a case control stud on Traditional 
Birth Attendants which compared their services with those provided at hospitals. does 
not, however, explain how these projects have impacted the ficld. - a 
professor at Lady Reading Hospital, confirms the petitioner's residency at this institution. While Dr. 
praises the petitioner's professionalism, rapport with patients and intelligence, - 
does not identify any specific contributions that have impacted the field. Other faculty at Lady Reading 
Hospital provide similar information. 
, an assistant professor of medicine at Drexel University, discusses the shortage of 
physicians trained to provide critical care medicine. The petitioner has also submitted a large amount 
of documentation to support this assertion. The issue of whether similarly-trained workers are 
available in the United States, however, is an issue under the jurisdiction of the De artment of Labor. 
New York State Dep't. of Transp., 22 I&N Dec. 2 15, 221 (Comrn'r. 1998). Pgoes on to assert 
that the petitioner "has led groundbreaking research that has had a direct impact on the future of the 
field throughout the world." Her one example of such research is the petitioner's study on the use of 
infliximab for refractory sarcoidosis, a devastating and potentially fatal inflammatory disease. 
v 
explains that patients suffering from multi-drug resistant sarcoidosis have limited therapeutic 
op ions and asserts that the petitioner was the first scientist to demonstrate that infliximab showed 
minimal side effects and enormous benefits for these patients. speculates that because of 
the petitioner's prior success in the research arena, "it is highly anticipated that this research will be 
vital in FDA approval of this drug to treat sarcoidosis." 
A review of the FDC Reports article on the seminar where the petitioner presented the results of his 
study, however, reveals that other physicians were already using infliximab to treat sarcoidosis, that 
these physicians confirmed the petitioner's observations and that the seminar included a "lively 
debate" on whether it was necessary to include methotrexate with infliximab. This article reveals 
that using infliximab off-label for sarcoidosis was nothing new at the time of the petitioner's small- 
scale study. whileasserts that the petitioner's research is "continuously cited in the research 
studies of other physicians," the record contains no evidence of any citations, such as citing articles 
or the results of a search on a citation tracking database. Significantly, the record contains no 
evidence that the petitioner's abstract of his infliximab study, which appeared in Chest has been cited 
and the record contains no letters from FDA officials confirming their interest in the petitioner's 
research or even that they are considering amending their approval of infliximab to include treatment 
of sarcoidosis. Finally, notes the prestigious journals that have carried the petitioner's 
research and concludes that only those studies that "will have a dramatic impact on the international 
medical community" are published in such journals. We will not presume the significance of an 
article from the journal in which it appeared. Rather, it is the petitioner's burden to demonstrate that 
his individual articles have impacted the field, such as through the submission of citation indices or 
other comparable evidence. 
claims no personal knowledge of the petitioner, but is a clinical Assistant Professor at 
an affiliate site of Drexel University. not establish the petitioner's 
recognition beyond Drexel University notes that the petitioner has 
presented and published his work and received travel awards. further asserts that the 
petitioner is able to perform the hi hly complex and difficult pericardiocentesis procedure to detect 
fluid in the pericardium. does not explain how an ability to perform a procedure developed 
by someone else, regardless of its complexity, constitutes an original contribution. 
Page 13 
discusses the petitioner's work with ventilator associated pneumonia (VAP), which is defined by 
required ventilation for at least 48 hours. The petitioner's study at Drexel University "assessed the 
diagnostic and prognostic value of the Clinical Pulmonary Infection Score (CPIS), which is a scoring 
s stem establishedto identify factors related with higher mortality in VAP patients." According to 
the studv demonstrated that antibiotics were not appropriately modified in VAP 
explains that the study "has numerous practical implications; 
it not only addresses the appropriate initial use of antibiotics but also the modification of antibiotics 
and their impact on mortality and length of hospital stay." does not provide examples 
of how this work is being applied at a national or international level. , a hospitalist 
- -- 
at the University of Pittsburgh, asserts that this work "directly led to improvements in treatment 
modalities" but provides no examples of where these improvements were adopted. - 
letter does not provide any evidence of the petitioner's recognition outside of Pennsylvania where he 
works. In his second letter, - asserts that the petitioner is distinguished by the fact that 
he is a top physician scientist. This circular assertion, unsupported by examples of the petitioner's 
impact in the field, is not persuasive evidence of the petitioner's sustained national or international 
acclaim in the field of medicine. 
an assistant professor at the Warren Albert Medical School of Brown University, 
does not explain how he became aware of the petitioner or his work. 
 asserts that the 
petitioner's selection to work at Drexel University and the Albert Einstein Medical Center 
demonstrates his tremendous reputation. We will discuss the nature of the petitioner's roles below as 
they relate to the criterion set forth at 8 C.F.R. 5 204.5(h)(3)(viii). We will not presume that being 
hired at a prestigious hospital creates a presumption that the physician has made an original 
contribution of major significance in the field. Rather, it is the petitioner's burden to identify any 
contribution and document its impact in the field. also asserts that the petitioner's 
reputation is apparent from his memberships and presentations. The petitioner's membership have 
been discussed above pursuant to the regulation at 8 C.F.R. 5 204.5(h)(3)(ii) and found insufficient 
to meet that criterion. The petitioner's presentations will be considered below pursuant to the 
regulation at 8 C.F.R. 5 204.5(h)(3)(vi). 
In a second letter, 
 concludes that the petitioner's research could not have been performed 
by any other practicing researcher simply because it was not performed by any other practicing 
researcher. This statement, however, applies to any clinical researcher publishing original work. We 
note that it would serve no purpose to publish work that is not original; thus, the vast majority of 
published work is original and was not performed by any other researcher previously. As stated 
above, mere publication is insufficient to meet this criterion. See Kazarian, 2009 WL 2836453 at *6. 
procedures that the petitioner has mastered and discusses a single complex patient that the petitioner 
was able to diagnose and treat. As stated above, the ability to perform procedures developed by 
others is not an original contribution. Moreover, we are not persuaded that the petitioner's successful 
diagnosis and treatment of a critical care patient separates him from other critical care physicians. 
As stated above, a shortage of workers with the petitioner's specialized skills falls under the 
jurisdiction of the Department of Labor and can be enumerated on an application for alien 
employment certification, Form 9089. Matter of New York State Dep't. of Transp., 22 I&N Dec. at 
220-2 1. 
asserts that the petitioner demonstrated, for the first time, that outpatient pleural 
catheters are a safe, less invasive and cost effective modalit for achieving palliation and pleurodesis 
in patients with Malignant Pleural Effusion (MPE). notes that the petitioner presented 
this work in 2006 at a conference attended by over 14,000 individuals. concludes that 
this study "has truly improved on a national level the ability of our field to deal with and treats [sic] 
this very serious disease." does not assert that his hospital, the University of 
Massachusetts Medical School, has changed its guidelines on treating MPE based on the petitioner's 
study and provides no examples of independent hospitals that have done so. Rather, he speculates: 
"I'm sure many of my peers have been able to utilize [the petitioner's study1 in their own clinical 
- A - 2 
practices in [aj very practical way." It is not even clear that 
 knew of the petitioner or his 
work prior to being contacted for a reference letter. 
a physician with Penobscot Respiratory, P.A. in Maine, asserts that he has been 
able to utilize several of the etitioner's findings to improve his own clinical practice and to further 
his own research. dprovides no examples of changes he has made to his practice based on 
the petitioner's work and the record lacks evidence that has published research that cites 
the petitioner's work as a foundation of the new research or otherwise. 
Brook, asserts that the etitioner is distinguished from his peers because of the wide ranging impact 
of his research. While explains that the petitioner's work is "very practical in nature" and 
lists several pulmonary diseases investigated by the petitioner, provides no examples of 
how the petitioner's work is being implemented at independent hospitals, including his own. 
While the petitioner's research is no doubt of value, it can be argued that any research must be shown 
to be original and present some benefit if it is to receive funding and attention from the scientific 
community. The record demonstrates that the petitioner has earned the respect of his immediate 
circle of colleagues and has possibly gained some recognition in the Pennsylvania-New England 
region. The record, however, lacks evidence of the petitioner's demonstrable impact on the practice 
of medicine, such as widespread citation or official hospital guidelines adopting procedures based on 
his results. Thus, the petitioner has not established that he meets this criterion. 
Evidence of the alien's authorship of scholarly articles in the field, in professional or major trade 
publications or other major media. 
The petitioner initially submitted several articles, a book chapter entitled "Chest Drains" allegedly "in 
press" in an Oxford Handbook and conference presentations. No authors are listed on the "Chest 
Drains" chapter. In response to the director's request for additional evidence, the petitioner submitted 
articles and a different book chapter published after the date of filing. While several references attest to 
the significance of the textbooks containing the petitioner's chapters, it remains that neither chapter 
predates the filing of the petition. Thus, the book chapters cannot be considered evidence of the 
petitioner's eligibility as of that date. See 8 C.F.R. 5 103.2(b)(l), (12); Matter of Katigbak, 4 I&N Dec. 
45,49 (Reg'l. Comrn'r. 1971). 
We reiterate that the evidence submitted to meet a given criterion must be indicative of or consistent 
with national or international acclaim. As discussed above, while two of the petitioner's references 
assert that the petitioner is continuously cited, the record contains no evidence of citation or other 
evidence of the impact of the petitioner's articles. Even if we accept the assertion advanced by several 
references that the publication of research is unusual for a physician, the petitioner would meet only this 
single criterion, of which an alien must meet at least three. 8 C.F.R. $204.5(h)(3). For the reasons 
discussed above and below, the petitioner falls far short of meeting any other criterion. 
Evidence that the alien has performed in a leading or critical role for organizations or 
establishments that have a distinguished reputation. 
Prior counsel initially stated that the petitioner plays a leading or critical role in the lives of his patients 
and his profession. While we do not discount the importance of patient care, a patient is not an 
organization or establishment and, thus, the petitioner's role with his patients cannot serve to meet the 
plain language of this criterion. Prior counsel also referenced the petitioner's "supervisory roles" and 
asserted that he is able to perform the most advanced and difficult diagnostic and clinical procedures, 
enabling and facilitating the widespread performance of these innovative procedures. The unsupported 
assertions of counsel do not constitute evidence. Matter of Obaigbena, 19 I&N Dec. 533,534 n.2 (BIA 
1988); Matter of Laureano, 19 I&N Dec. 1, 3 n.2 (BIA 1983); Matter of Ramirez-Sanchez, 17 I&N 
Dec. 503,506 (BIA 1980). 
The exhibit labeled "Leading and Critical Roles" includes a lengthy self-serving description of all of the 
petitioner's physician duties, a list of Procedural Skill Documentation forms signed by the petitioner as 
the supervising physician and internet materials about the Albert Einstein ~edical ~ente; and Drexel 
-- - 
University. Several references, including coauthor - of Drexel University, attest to 
the petitioner's leading role on various research projects., an attending physician 
at the Robert Wood Johnson University Hospital in Hamilton, New Jersey, asserts that the petitioner 
has served in leading roles at prominent institutions such as the Albert Einstein Medical Center but 
provides no job title to suppoi this assertion. The record contains the petitioner's actual employment 
contract for his position with the Albert Einstein Medical Center indicating that the petitioner was hired 
as and serves in a graduate training position. 
The director did not address this criterion. On appeal, counsel asserts that the director disregarded 
evidence that the petitioner was appointed to selective leading and critical roles at top institutions in 
Pakistan and the United States. 
We have already considered the petitioner's research contributions above. At issue for this criterion are 
the nature of the job the petitioner was selected to fill and the reputation of the entity that selected him. 
In other words, the nature of the job must be such that the selection of the petitioner to fill this role is 
indicative of or consistent with national or international acclaim. While the petitioner submitted no 
evidence as to the reputation of the Pakistani institutions where he worked, we do not contest the 
distinguished reputation of the U.S. institutions that have hired him. At issue in this matter, then, is the 
nature of the positions the petitioner was hired to fill. 
The letters from the Pakistani institutions state that the petitioner worked in a residency position at 
those institutions. We are not persuaded that a training position is a leading or critical role for the 
institution. Similarly, while the petitioner may have had some supervisory responsibilities in the 
United States, he was hired into a primarily training position according to his contract. The record 
lacks an organizational chart or other evidence establishing how his job positions fit within the 
hierarchy of the institutions where he has worked. 
As the petitioner appears to have worked only as a medical resident, we are not persuaded that he meets 
this criterion, which contemplates a job title beyond graduate training. 
The documentation submitted in support of a claim of extraordinary ability must clearly demonstrate 
that the alien has achieved sustained national or international acclaim and is one of the small percentage 
who has risen to the very top of the field of endeavor. 
Review of the record, however, does not establish that the petitioner has distinguished himself as a 
physician 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 indicates that the 
petitioner shows talent as a physician, but is not persuasive that the petitioner's achievements set him 
significantly above almost all others in his field. 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. 5 1361. Here, the petitioner has not sustained that burden. Accordingly, the appeal 
will be dismissed. 
ORDER: The appeal is dismissed.