dismissed EB-1A Case: Plastic Surgery

, identifying data deleted to 
prevent clearly unwarranted 
invasion of personal pnvacv 
PUBLIC COpy 
FILE: Office: NEBRASKA SERVICE CENTER 
INRE: Petitioner: 
Beneficiary: 
u.s. Department of Homeland Security 
U.S. Citizenship and Irrnnigration Services 
Office of Administrative Appeals MS 2090 
Washington, DC 20529-2090 
U. S. Citizenship 
and Immigration 
Services 
Date: 
NOV 01 2DlD 
PETITION: Immigrant Petition for Alien Worker as an Alien of Extraordinary Ability Pursuant to 
Section 203(b)(1)(A) of the Immigration and Nationality Act; 8 U.S.C. § 1153(b)(1)(A) 
ON BEHALF OF PETITIONER: 
INSTRUCTIONS: 
Enclosed please find the decision of the Administrative Appeals Office in your case. All of the 
documents related to this matter have been returned to the office that originally decided your case. Please 
be advised that any further inquiry that you might have concerning your case must be made to that office. 
If you believe the law was inappropriately applied by us in reaching our decision, or you have additional 
information that you wish to have considered, you may file a motion to reconsider or a motion to reopen. 
The specific requirements for filing such a request can be found at 8 C.F.R. § 103.5. All motions must be 
submitted to the office that originally decided your case by filing a Form I-290B, Notice of Appeal or 
Motion. The fee for a Form 1-290B is currently $585, but will increase to $630 on November 23,2010. 
Any appeal or motion filed on or after November 23, 2010 must be filed with the $630 fee. Please be 
aware that 8 C.F.R. § 103.5(a)(1)(i) requires that any motion must be filed within 30 days of the decision 
that the motion seeks to reconsider or reopen. 
erry Rhew 
Chief, Administrative Appeals Office 
www.uscis.gov 
, . 
Page 2 
DISCUSSION: The employment-based immigrant visa petition was denied by the Director, 
Nebraska Service Center, on August 17,2009, and is now before the Administrative Appeals Office 
(AA 0) on appeal. The appeal will be dismissed. 
The petitioner seeks classification as an employment-based immigrant pursuant to section 
203(b)(l)(A) of the Immigration and Nationality Act (the Act), 8 U.S.C. § 1153(b)(l)(A), as an 
alien of extraordinary ability as a plastic surgeon specializing in wound care. The director 
determined that the petitioner had not established the requisite extraordinary ability and failed to 
submit extensive documentation of his sustained national or international acclaim. 
Congress set a very high benchmark for aliens of extraordinary ability by requiring through the 
statute that the petitioner demonstrate "sustained national or international acclaim" and present 
"extensive documentation" of his or her achievements. See section 203(b)(1)(A)(i) of the Act 
and 8 C.F.R. § 204.5(h)(3). The implementing regulation at 8 C.F.R. § 204.5(h)(3) states that an 
alien can establish sustained national or international acclaim through evidence of a one-time 
achievement, specifically a major, internationally recognized award. Absent the receipt of such 
an award, the regulation outlines ten categories of specific evidence. 8 C.F.R. §§ 204.5(h)(3)(i) 
through (x). The petitioner must submit qualifying evidence under at least three of the ten 
regulatory categories of evidence to establish the basic eligibility requirements. 
On appeal, counsel claims that the petitioner meets at least three of the regulatory criteria at 8 
C.F.R. § 204.5(h)(3). 
I. Law 
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 
Page 3 
(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 H.R. 723 101 5t Cong., 2d 
Sess. 59 (1990); 56 Fed. Reg. 60897, 60898-99 (Nov. 29, 1991). 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. Id. and 8 C.F.R. § 204.5(h)(2). 
The regulation at 8 C.F.R. § 204.5(h)(3) requires that the petitioner demonstrate his or her sustained 
acclaim and the recognition of his or her achievements in the field. Such acclaim must be 
established either through evidence of a one-time achievement (that is, a major, international 
recognized award) or through the submission of qualifying evidence under at least three of the 
following ten categories of evidence. 
(i) Documentation of the alien's receipt of lesser nationally or internationally 
recognized prizes or awards for excellence in the field of endeavor; 
(ii) Documentation of the alien's membership in associations in the field for which 
classification is sought, which require outstanding achievements of their members, 
as judged by recognized national or international experts in their disciplines or 
fields; 
(iii) 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 classification is 
sought. Such evidence shall include the title, date, and author of the material, and 
any necessary translation; 
(iv) Evidence of the alien's participation, either individually or on a panel, as ajudge 
of the work of others in the same or an allied field of specialization for which 
classification is sought; 
(v) Evidence ofthe alien's original scientific, scholarly, artistic, athletic, or business­
related contributions of major significance in the field; 
(vi) Evidence of the alien's authorship of scholarly articles In the field, In 
professional or major trade publications or other major media; 
(vii) Evidence of the display of the alien's work in the field at artistic exhibitions or 
showcases; 
(viii) Evidence that the alien has performed in a leading or critical role for 
organizations or establishments that have a distinguished reputation; 
• 
... 
Page 4 
(ix) Evidence that the alien has commanded a high salary or other significantly high 
remuneration for services, in relation to others in the field; or 
(x) Evidence of commercial successes in the performing arts, as shown by box office 
receipts or record, cassette, compact disk, or video sales. 
In 2010, the U.S. Court of Appeals for the Ninth Circuit (Ninth Circuit) reviewed the denial of a 
petition filed under this classification. Kazarian v. USCIS, 596 F .3d 1115 (9th Cir. 2010). Although 
the court upheld the AAO's decision to deny the petition, the court took issue with the AAO's 
evaluation of evidence submitted to meet a given evidentiary criterion.l With respect to the criteria 
at 8 C.F.R. §§ 204.5(h)(3)(iv) and (vi), the court concluded that while USCIS may have raised 
legitimate concerns about the significance of the evidence submitted to meet those two criteria, 
those concerns should have been raised in a subsequent "final merits determination." Id. 
The court stated that the AAO's evaluation rested on an improper understanding of the regulations. 
Instead of parsing the significance of evidence as part of the initial inquiry, the court stated that "the 
proper procedure is to count the types of evidence provided (which the AAO did)," and if the 
petitioner failed to submit sufficient evidence, "the proper conclusion is that the applicant has failed 
to satisfy the regulatory requirement of three types of evidence (as the AAO concluded)." Id. at 
1122 (citing to 8 C.F.R. § 204.5(h)(3)). The court also explained the "final merits determination" as 
the corollary to this procedure: 
If a petitioner has submitted the requisite evidence, USCIS determines whether the 
evidence demonstrates both a "level of expertise indicating that the individual is one 
of that small percentage who have risen to the very top of the [ir] field of endeavor," 
8 C.F.R. § 204.5(h)(2), and "that the alien has sustained national or international 
acclaim and that his or her achievements have been recognized in the field of 
expertise." 8 C.F.R. § 204.5(h)(3). Only aliens whose achievements have garnered 
"sustained national or international acclaim" are eligible for an "extraordinary 
ability" visa. 8 U.S.c. § 1153(b)(1 )(A)(i). 
Id. at 1119. 
Thus, Kazarian sets forth a two-part approach where the evidence is first counted and then 
considered in the context of a final merits determination. In reviewing Service Center decisions, the 
AAO will apply the test set forth in Kazarian. As the AAO maintains de novo review, the AAO 
will conduct a new analysis if the director reached his or her conclusion by using a one-step analysis 
rather than the two-step analysis dictated by the Kazarian court. See Spencer Enterprises, Inc. v. 
United States, 229 F. Supp. 2d 1025, 1043 (E.D. Cal. 2001), afj'd, 345 F.3d 683 (9th Cir. 2003); 
see also Soltane v. DOJ, 381 F.3d 143, 145 (3d Cir. 2004) (noting that the AAO conducts 
appellate review on a de novo basis). 
1 Specifically, the court stated that the AAO had unilaterally imposed novel, substantive, or evidentiary requirements 
beyond those set forth in the regulations at 8 C.F.R. § 204.5(h)(3)(iv) and 8 C.F.R. § 204.5(h)(3)(vi). 
Page 5 
II. Analysis 
A. Evidentiary Criteria 
The petitioner has submitted evidence pertaining to the following criteria under 8 C.F.R. 
§ 204.5(h)(3). 2 
Evidence of the alien's original scientific, scholarly, artistic, athletic, or business­
related contributions of major significance in the field 
At the time of the original filing of the petition, the petitioner claimed eligibility for this criterion 
based on the submission of eight recommendation letters and various speaking engagements at 
approximately sixteen seminars and conferences. In response to the director's request for 
evidence, the petitioner submitted an additional seven recommendation letters, as well as 
documentary evidence reflecting an additional sixteen lectures and speaking engagements. In 
the director's decision, he found that the petitioner's publications were "cited by others 
approximately 102 times" and ultimately concluded that the documentary evidence submitted by 
the petitioner "failed to establish that [the petitioner's] work has influenced, or been recognized 
by, others in his field to such a degree that it could be considered contributions of major 
significance. " 
On appeal, counsel argues: 
[T]he Director did not apply the correct regulatory standard. [The petitioner] was 
required to present evidence of his "original scientific, scholarly, artistic, athletic, 
or business related contributions" of major significance in his field. 8 C.F.R. 
§ 204.5(h)(3)(v) (emphasis added). The requirement is clearly in the disjunctive, 
but the Director approached [the petitioner's] evidence solely from the point of 
view of what was "scholarly," focusing on how often [the petitioner's] articles in 
his field have been cited. 
* * * 
In focusing solely on the scholarly, the Director ignored evidence from [the 
petitioner] of his major scientific contributions for the treatment of hard-to-heal 
wounds. . .. [The petitioner] submitted testimony from leading medical 
authorities in Israel and industry experts on his pioneering role in the introduction 
and use of such techniques as ozone and oxygen, vacuum assisted closure, 
activated macrophages, "Lifewave" technology, low energy laser, ultrasound, and 
advanced dressings. 
* * * 
2 The petitioner does not claim to meet or submit evidence relating to the criteria not discussed in this decision. 
-Page 6 
[I]n light of the nature of [the petitioner's] accomplishments and the nature of his 
occupation as a clinician rather than a researcher, the best evidence of those 
accomplishments and that acclaim was the testimony [the petitioner] presented of 
experts familiar with his work. 
While we agree with counsel that the petitioner's field is more scientific rather than scholarly, we 
find that the director's evaluation of the petitioner's citation history is appropriate in determining 
that the petitioner's work has been "of major significance in the field." As counsel has emphasized 
the petitioner's recommendation letters on appeal, we will first address the recommendation letters 
and then evaluate the petitioner's citation history and conference and seminar presentations. 
The plain language of the regulation at 8 C.F.R. § 204.5(h)(3)(v) requires "[e]vidence of the 
alien's original scientific, scholarly, artistic, athletic, or business-related contributions of major 
significance in the field." In compliance with Kazarian, the AAO must focus on the plain 
language of the regulatory criteria. 596 F.3d at 1121. Here, the evidence must be reviewed to see 
whether it rises to the level of original scientific-related "contributions of major significance in 
the field." 
In this case, while the recommendation letters praise the petitioner for his work in wound care, 
they fail to indicate that he has made original contributions of major significance in the field. 
The letters provide only general statements without offering any specific information to establish 
how the petitioner's work has been of major significance. For example: 
Surgeon General of the Israel Defense Force (IDF), stated: 
[I]n addition to his service as an airborne physician, [the petitioner] has been 
caring for IDF soldiers within his civilian occupation as a specialist in plastic 
surgery and as a leader in the field of wound healing. [The petitioner] has cared 
for IDF casualties who were injured in the war in Lebanon last year and who were 
transferred to Sheba Medical Center [SMC] for further care. [The petitioner] also 
advises the Medical Corps on the care of casualties with difficult to heal wounds. 
While_briefly described the petitioner as a leader in wound healing, he failed to indicate 
any contributions that were both original and of major significance to the field as a whole .• 
.. failed to provide any evidence demonstrating that the petitioner's work has significantly 
impacted the field beyond the limited number of patients he has treated. 
Director of Sheba General Hospital, stated: 
[The petitioner] was one of the first physicians in Israel to use the KCI Vacuum 
Assisted Closure (V AC) device to treat acute and chronic wounds. 
* * * 
, . 
-Page 7 
Activated Macrophages are living human cells that were activated in the 
laboratory and injected into the wound surface. It's a very unique technology that 
was developed at the central MDA Israeli Blood bank research unit and has a 
powerful effect on wound healing. [The petitioner] is involved in ongoing 
clinical studies on the effects [of] this technology and is making a major 
contribution in its utilization. 
* * * 
"Lifewave" is another high-tech technology that issues an electrical current to the 
edges of chronic wounds. Our wound care center has a few of these devices. 
[The petitioner] has also made a major contribution in the development of this 
technology. 
Polyheal is a solution made of microscopic latex beads in a nutrient base. It is 
used as a powerful granulation tissue simulator intended for use on complicated 
wounds with exposed bone or tendon. [The petitioner] has the most extensive 
experience in the world with this technology and runs a multi-centered, 
randomized double blind clinical study to explore its efficacy. 
Other advanced technologies that are being employed by [the petitioner] are low 
energy laser, ultrasound assisted venous sclerosation and high focused ultrasound 
pulsation for arterial insufficiency. 
Although described several technologies that the petitioner utilizes, they fail to 
reflect original contributions made by the petitioner. We are not persuaded that an expert 
with a specific technology also demonstrates an original contribution. In fact, 
that activated macrophages were "developed at the central MDA Israeli Blood bank research 
unit" and not by the petitioner so as to establish an original contribution. Furthermore, while. 
_ indicated that the petitioner has made major contributions, he failed to indentify those 
contributions. Instead, _indicated that the petitioner was involved with "ongoing 
clinical studies" without evidence establishing that his clinical studies have been of major 
significance to the field. 
Medical Center (SMC) in Israel, stated: 
[The petitioner] pioneered the reconstruction of a multidisciplinary wound care 
center in Israel and currently he serves as the head of this service at the Sheba 
Medical Center. [The petitioner's] service has the annual capacity of treating 
2000 outpatients cases every a [sic] year and performing over 200 cases of major 
flap surgeries annually. The wound care service introduces advanced 
conservative procedures such as V AC systems, modem wound care applications 
, .. 
Page 8 
among which [the petitioner] has introduced and established the unique 
macrophage treatment for chronic wound closure. Macrophage - cellular therapy 
for chronic wounds is a world [sic] novel scientifically proved method for the 
harvesting and using self and donor macrophages for treating refractory chronic 
wounds. 
stated that the petItIOner "introduced and established the unique macrophage 
treatment for chronic wound closure." However, _ did not indicate that the petitioner 
created or developed the macrophage treatment; only that the petitioner introduced and 
established it at the SMC. We are not persuaded that merely introducing a treatment that was 
developed by someone else can be considered an original contribution. Even if the petitioner 
developed the macrophage treatment, failed to indicate that the treatment is utilized 
throughout the field and not limited to the SMC. 
Specialist, stated: 
I know [the petitioner] from our joined work at [SMC]. Together we established 
an educational program in the hospital to prevent pressure sores and educate the 
staff in treating chronic wounds. [The petitioner] is a very popular and talented 
lecturer in wound care. 
While _ stated that the petitioner established an educational program at SMC,_ 
failed to not only describe the significance of the educational program to the field as a whole but 
also failed to indicate the impact of the program within SMC. 
stated: 
Many dozens of our veterans owe their well being to [the petitioner] and his 
personal skills, his knowledge of when to operate or wait and treat the wound 
conservatively until it heals and they are able to return to their routine. I am 
following his work very closely and I see him bringing new techniques and new 
ideas. [The petitioner] gained a lot of experience in treating pressure sores with 
activated macrophages, a technology that exists only in Israel. [The petitioner] 
investigates and populates technologies like electrical stimulation, vacuum 
assisted closure device and local ozone therapy. [The petitioner] developed a 
treatment regimen for paraplegic patients with pressure sores that involves local 
wound care, patient education, pressure sore prevention, nutritional support and 
criteria for surgical intervention. [The petitioner's] special surgical approach has 
high success rate and low recurrence rate. 
Although _ indicated that the petitioner developed a treatment regimen, he failed to 
specifically identify the treatment regimen and only generally stated that it involved wound care, 
patient education, pressure sore prevention, nutritional support, and surgical intervention criteria. 
Regardless,_failed to indicate that this unnamed treatment regimen has been of major 
." 
-Page 9 
significance to the field such as evidence demonstrating that other wound care hospitals have 
changed their wound care to paraplegic patients based on the petitioner's treatment regimen. 
- Israel, stated: 
It is clear that in light of [the petitioner's] experience in the area of wound care, 
his wide knowledge of the subject, his presentation skills and his fluent English 
are all factors that contribute to [the petitioner] being a [sic] an important and 
dominant partner for our wound care activities in Israel and around the world. 
While _ recognized the petitioner's experience and knowledge in wound care, she 
failed to identify any original contributions made by the petitioner. Simply participating in 
lectures or studies is insufficient to establish eligibility for this criterion without evidence 
demonstrating that the petitioner has made original contributions of major significance to the 
field of medicine. 
stated: 
[The petitioner] has done extensive research usmg Negative Pressure as 
adjunctive therapy in delicate plastic surgical techniques which have been 
invaluable in reducing costs and improving the outcomes. With the elevation of 
considerations of patient "pain" now in the forefront of treatment, his knowledge 
and participation in research trials including the innovative Biatain Ibu™ dressing 
for pain reduction in chronic wounds will be invaluable in adding to our current 
knowledge of techniques to improve our pain control as we promote wound 
healing. With the dramatic increase in diabetic related wounds here in the U.S. 
newer and novel techniques for treatment will be needed. [The petitioner] has 
been involved in testing activated macrophage injection research regarding these 
problems, a novel consideration which appears to have great potential especially 
in advanced wounds such as those with exposed bone and tendon which have the 
highest propensity to be high cost, and have the poorest outcomes. There is no 
question that a health care professional of his training, education and caliber will 
provide innovative, cost effective, quality wound care to the people and health 
care system here in the United States. 
Although _ mentioned that the petitioner's research regarding Negative Pressure has 
reduced costs and improved outcomes, he failed to describe how the petitioner's research has 
reduced costs or improved outcomes. We cannot make a favorable finding for this criterion 
based on general or broad statements. Furthermore, _ indicated that the petitioner's 
research "will be invaluable (emphasis added)," "[has] great potential (emphasis added)," and 
"will provide innovative, cost effective, quality wound care (emphasis added)." Eligibility must 
be established at the time of filing. 8 C.F.R. §§ 103.2(b)(1), (12); Matter of Katigbak, 14 I&N 
Dec. 45, 49 (Regl. Commr. 1971). A petition cannot be approved at a future date after the 
petitioner becomes eligible under a new set of facts. Matter of Izummi, 22 I&N Dec. 169, 175 
· . 
,-
-Page 10 
(Comm'r. 1998). That decision further provides, citing Matter of Bardouille, 18 I&N Dec. 114 
(BIA 1981), that we cannot "consider facts that come into being only subsequent to the filing of 
a petition." Id. at 176. A petitioner cannot file a petition under this classification based on the 
expectation of future eligibility. The assertion that the petitioner's work is likely to be influential 
is not adequate to establish that his findings are already recognized as major contributions in the 
field. While_praises the petitioner, the fact remains that any measurable impact that 
results from the petitioner's research will likely occur in the future. 
Adjunct Associate Professor at the University of Medicine and Dentistry of 
New Jersey, stated: 
After careful consideration of [the petitioner's] qualifications as a plastic surgeon 
who understands and implements evidence-based wound care in his practice, he 
was invited to join our team. Despite a busy career and a young family, [the 
petitioner] joined the AA WC Guideline Department in January 2009, and has 
actively donated his time and energy to its pressure ulcer guideline project. His 
extensive knowledge and surgical expertise have contributed importantly to the 
success of this project, which will result this year in a comprehensive evidence­
based, content-validated pressure ulcer guideline with the potential to improve 
consistency and quality of pressure ulcer management throughout the United 
States and around the world. 
The petition was filed on November 28,2008, and_refers to the petitioner's joining of 
the AAWC Guideline Department in January 2009. We cannot consider events occurring after 
the filing of the petition. Eligibility must be established at the time of filing. 8 C.F .R. 
§§ 103.2(b)(1), (12); Matter of Katigbak, 14 I&N Dec. at 49. A petition cannot be approved at a 
future date after the petitioner becomes eligible under a new set of facts. Matter of Izummi, 22 
I&N Dec. at 175. That decision further provides, citing Matter of Bardouille, 18 I&N Dec. at 
114, that we cannot "consider facts that come into bein~equent to the filing of a 
petition." Id. at 176. Regardless, similar to ___ described the petitioner's 
work in terms of future probability such as "will result this year" and "the potential to improve." 
stated: 
[The petitioner] is one of only two physicians world-wide that has taken the 
initiative to integrate the [FMC] dressings into his daily practice, explore the wide 
range of benefits his patients could achieve through the use of dressings and 
present his results at national and international wound care meetings. [The 
petitioner], on his own initiative and without any support from [FMC], has 
presented his extensive clinical results at wound care society meetings for the 
purpose of educating the larger medical community about how to improve the 
care of their patients through the use of [FMC] wound dressings. One of the 
. ' 
· . 
Page 11 
important results of his research has been how to improve the care of skin graft 
donor sites through the use of [FMC] wound dressings. 
We are not persuaded that the letter from demonstrates any original contributions 
made by the ~he field. In fact, . the original contributions of 
FMC. While ___ stated that the petitioner is one of only two physicians to incorporate 
the FMC dressings into his daily practice, this is not reflective of an original contribution by the 
petitioner. Furthermore, even if we found that this was an original contribution, which we do 
not, to elaborate on the impact or influence of the FMC dressings to the field 
as a whole and not limited to the petitioner and another physician. We are not persuaded that 
only two physicians are integrating the FMC dressings demonstrates that it has been of major 
significance to the field. 
We note here that submitted a second recommendation letter in response to the 
director's request for evidence. While _ reiterates his praise for the petitioner, • 
••• also refers to the 8th Annual American Professional Wound Care Association from April 
2 - 5, 2009, in Philadelphia, PA where the petitioner made presentations on managing skin graft 
donor sites and managing painful sebaceous and pilonidal cysts. However, the conference 
occurred after the filing of the petition. Eligibility must be established at the time of filing. 8 
C.F.R. §§ 103.2(b)(1), (12); Matter of Katigbak, 14 I&N Dec. at 49. A petition cannot be 
approved at a future date after the petitioner becomes eligible under a new set of facts. Matter of 
Izummi, 22 I&N Dec. at 175. That decision further provides, citing Matter of Bardouille, 18 
I&N Dec. at 114, that we cannot "consider facts that come into being only subsequent to the 
filing of a petition." Id at 176. Nonetheless, _ failed to demonstrate how the 
petitioner's presentations have significantly impacted the field. 
stated: 
In the clinic setting, I have a 19 year old male with a severe case of rare condition 
Epidermolysis Bulosa. While under my care, a number of co-morbid conditions 
not addressed by his previous pediatrician have been identified and treated 
yielding in improved quality of life. His chronic wounds are unique to his 
disease. The severity and chronicity of these wounds are painful, debilitating and 
ultimately fatal for the victims. [The petitioner] has had expertise with these 
patients before and has been successful in healing wounds that have plagued this 
patient for years. To be more specific, [the petitioner] has worked with me to heal 
wounds and improve quality of life for a patient who had been literally ignored to 
die by other primary care physicians and specialist in this community. 
Again, the regulation at 8 C.F.R. § 204.5(h)(3)(v) requires the petitioner to demonstrate his 
original contributions of major significance "in the field." In this case, _credits the 
petitioner with assisting him in healing the wounds of a single patient. While the petitioner's 
treatment of the patient is admirable, we are not persuaded that the treatment of a single patient 
Page 12 
demonstrates that the petitioner has made original contributions of major significance to the field 
as a whole and not limited to a single patient. 
stated: 
[The petitioner's] services at Susan B. Allen Memorial Hospital will significantly 
contribute to the provision of emerging treatments for a variety of reconstructive 
plastic surgery and wound care. The necessity of wound care treatments, 
including surgical procedures, continues to grow as a result of the prevalence of 
diabetes in our population. We are pleased to have the expertise of [the 
petitioner] as he joins our Medical Staff as our wound care specialist. [The 
petitioner's] services will greatly enhance the health of the people we serve . 
••••• failed to provide any evidence of the petitioner's past or current original 
contributions. In fact, _ described the petitioner's contributions based on possible or 
potential contributions such as "will significantly contribute (emphasis added)" and "will greatly 
enhance the health of the people (emphasis added)." Eligibility must be established at the time 
of filing. 8 C.F.R. §§ 103.2(b)(1), (12); Matter of Katigbak, 14 I&N Dec. at 49. A petition 
cannot be approved at a future date after the petitioner becomes eligible under a new set of facts. 
Matter of Izummi, 22 I&N Dec. at 175. That decision further provides, citing Matter of 
Bardouille, 18 I&N Dec. at 114, that we cannot "consider facts that come into being only 
subsequent to the filing of a petition." Id. at 176. Notwithstanding, mentioned the 
petitioner's impact upon the people served at the Susan B. Allen Memorial Hospital and not the 
petitioner's contributions to the medical field as a whole. 
[The petitioner] was a pioneer in the field of wound heeling [sic] in our medical 
center and in Israel. He is the founder and the chairman ••••••••• 
he moved 
to the US). [The petitioner] made major contributions to the Wound Care field in 
Israel. He was heavily involved with research and development of 
technologies and was the only plastic surgeon in Israel who had a 
dedicated to wound care. The establishment 
_ together with the first national m 
~oth led by [the petitioner]) were maj or breakthrough[ s] in this field. [The 
petitioner] had crucial rule [sic] in developing new technologies like activated 
macrophage injection, PolyHeal micro spheres, Lifewave BST device, FlowAid 
device and Ozone wound care technology. 
Although stated that the petitioner made major contributions to wound care, he 
referred to the contributions in broad terms such as "heavily involved in research" without 
identifying the significant impact of the research. In addition, while _ stated that 
-Page 13 
IWHS and wee were major breakthroughs in wound care, he failed to explain how they were 
break~hin the meaning of major significance to the field of medicine. Likewise, 
while __ indicated that the petitioner had a crucial role in developing new technologies 
and provided examples of the technologies, he failed to define those crucial roles. _ 
failed to establish, for example, that any of the new technologies were developed by the 
petitioner so as to establish that they were the petitioner's original contributions of major 
significance to the field. 
stated: 
Due to [the petitioner's] very unique skills we chose him to be a consultant to our 
company, PolyHeal and later he became the chief medical advisor for our multi­
centered double blind clinical study. Treating hundreds of patients with our 
product, [the petitioner] has the largest experience in the world with PolyHeal 
microspheres. He had the crucial role in finding the current clinical indications 
for the product. 
also indicated that the petitioner used to be a medical consultant for the following 
compames: 
l. 
2. 
3. 
4. 
In addition,_indicated that the petitioner "was heavily involved with international 
wound care companies experiencing new products before they were introduced": 
A. 
B. 
c. 
D. 
We are not persuaded that the letter from reflects any original contributions made 
by the petitioner. While the petitio~e acted as a medical consultant for companies 
that develop wound care products, __ failed to demonstrate that the petitioner was 
responsible or credited with developing or creating any of the wound care products so as to 
establish that they are original contributions. While the petitioner may have treated patients 
using these products, the record falls far short in considering these products as the petitioner'S 
original contributions of major significance to the field. 
Finally, stated: 
, 
" 
Page 14 
[The petitioner] has the most extensive clinical experience in our technology and 
was using it heavily at his wound care clinics at [SMC] and Bnei Brak. He had a 
crucial rule [sic] in developing and directing the clinical research. He was also 
involved in development of different indications for our technology like deep vein 
thrombosis (DVT) prophylaxis and reversing sensory neuropathy. These two 
indications are revolutional [sic] breakthrough in medicine. Peripheral 
neuropathy is a devastating nerve injury causing severe ulcers and pain especially 
in diabetic patients. DVT is one of the leading causes of sudden death. 
Similar to letter, _ broadly described the petitioner's contributions in 
terms of "developing and directing the clinical research" and "involved in development of 
different indications for our technology." However, _ failed to describe the clinical 
research developed by the petitioner or specifically indicated the "different indications." 
Moreover, the letter reflects that EBMDL created the technology of "a small electro-muscular 
stimulator that activates the calf muscles with 4 electrodes." While the petitioner was involved 
with the research, the record reflects that the original contribution was made by EBMDL, and 
there is insufficient documentary evidence demonstrating that this technology can be originally 
attributed to the petitioner. In addition, _ failed to indicate in his letter the influence or 
impact of the technology on the field. 
While those familiar with the petitioner's work generally describe it as "pioneering," "leading," 
and "innovative," the letters contain general statements that lack specific details to demonstrate 
that the petitioner's work is both original and of major significance. This regulatory criterion not 
only requires the petitioner to make original contributions, but also requires those contributions 
to be significant. We are not persuaded by vague, solicited letters that simply repeat the 
regulatory language but do not explain how the petitioner's contributions have already influenced 
the field. Merely repeating the language of the statute or regulations does not satisfy the 
petitioner's burden of proof.3 The lack of supporting documentary evidence gives the AAO no 
basis to gauge the significance of the petitioner's present contributions. 
Moreover, as indicated above, some of the recommendation letters gave descriptions in terms of 
future applicability and determinations that may occur at a later date. It appears that the 
petitioner's work is still ongoing and that the findings he has made are not currently being 
implemented in his field. The letters do not indicate that anyone is currently applying the 
petitioner's research findings so as to establish that these findings have already impacted the field 
in a significant manner. Accordingly, the actual present impact of the petitioner's work has not 
been established. Rather, the petitioner's references appear to speculate about how the 
petitioner's findings may affect the field at some point in the future. Eligibility must be 
established at the time of filing. 8 C.F.R. §§ l03.2(b)(1), (12); Matter ofKatigbak, 14 I&N Dec. 
at 49. A petition cannot be approved at a future date after the petitioner becomes eligible under a 
new set of facts. Matter of /zummi, 22 I&N Dec. at 175. That decision further provides, citing 
3 Fedin Bros. Co., Ltd v. Sava, 724 F. Supp. 1103, 1108 (E.D.N.Y. 1989), ajj'd, 905 F. 2d 41 (2d. Cir. 1990); Avyr 
Associates, Inc. v. Meissner, 1997 WL 188942 at *5 (S.D.N.Y.). 
.' 
-Page 15 
Matter of Bardouille, 18 I&N Dec. at 114, that we cannot "consider facts that come into being 
only subsequent to the filing of a petition." Id. at 176. A petitioner cannot file a petition under 
this classification based on the expectation of future eligibility. The assertion that the petitioner's 
work will likely be influential is not adequate to establish that his findings are already recognized 
as major contributions in the field. While the experts praise the petitioner's work as both 
innovative and of great potential interest, the fact remains that any major impact on the field of 
medicine that results from the petitioner's work will likely occur in the future. 
USCIS may, in its discretion, use as advisory opinion statements submitted as expert testimony. 
See Matter of Caron International, 19 I&N Dec. 791, 795 (Commr. 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 of support from the petitioner's personal contacts 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. Thus, the content of the writers' 
statements and how they became aware of the petitioner's reputation are important 
considerations. Even when written by independent experts, letters solicited by an alien in 
support of an immigration petition are of less weight than preexisting, independent evidence of 
original contributions of major significance. 
Regarding the petitioner's citations, we reiterate that the petitioner never claimed eligibility for 
this criterion based on the citation of his work by others. Instead, the petitioner submitted 
documentary evidence regarding his citations in order to establish eligibility under the scholarly 
articles criterion pursuant to the regulation at 8 C.F.R. § 204.5(h)(3)(vi). We find that it is 
appropriate to evaluate and discuss the petitioner's citations under the original contributions 
criterion. While the number of total citations is a factor, it is not the only factor to be considered 
in determining the petitioner's eligibility for this criterion. Generally, the number of citations is 
reflective of the petitioner's original findings and that the field has taken some interest in the 
petitioner's work. However, it is not an automatic indicator that the petitioner's work has been of 
major significance in the field. In this case, the petitioner submitted documentary evidence from 
WWW.scopus.com reflecting that his work has been cited 103 times. Specifically, the record reflects 
the following citations: 
1. "Tumor Prostaglandin Levels Correlate with Edema Around Supratentorial 
Meningitis" - 32 citations; 
2. "Dermatobia Hominis MyIasis Among Travelers Returning from South 
America" - 15 citations;4 
3. "Treatment of Rhinophyma with ER:YAG Laser" - 9 citations; 
4. "Positive Changes in Sun-Related Behavior in Israel (1994 - 1998)" - 9 
citations; 
5. "Total Lower Lip Reconstruction with Innervated Muscle-Bearing Flaps: A 
Modification of the Webster Flap" - 9 citations; 
4 We note that the petitioner cited himself one time in the article, ••••••• 
Travelers. " 
.' 
-Page 16 
6. "Myiasis with Lund's·Fly (Cordylobia Rodhaini) in Travelers" - 8 citations; 
7. "Turnover Forehead Flap Combined with Composite Crus of Helix Graft for 
Partial Nasal Reconstruction" - 8 citations;5 
8. "Breast Augmentation with Fresh-Frozen Homologous Fat Grafts" - 7 
citations; 
9. "The Versatility, of the Nasolabial Flap Enhanced by the Delay Procedure"-
2 citations; 
1 o. "Silicone Breast Implants with Silicone Gel and Autoimmune Diseases -
Are They Related?" - 2 citations; 
11. "Necrotizing Periorbital Cellulitis Following Aesthetic Rhinoplasty" - 1 
citation; and 
12. "A Comparison Between C02 Laser Surgery With and Without Late Ral 
Fold Vaporization for Ingrowing Toenails" - 1 citation. 
We are not persuaded that the total number of 103 citations is reflective that the petitioner's work 
has been of major significance to the field. As indicated above, the petitioner's most cited article, 
item 1, has been cited 32 times, and the petitioner's second most cited article has been cited 15 
times. Moreover, the remaining ten articles have been cited less than ten times, with four of those 
articles cited once or twice. The petitioner failed to demonstrate that his work has been unusually 
influential, such as articles that discuss in-depth the petitioner's findings or credit the petitioner with 
influencing or impacting the field of medicine. In this case, the petitioner's documentary evidence is 
not reflective of having a significant impact on the field. Merely submitting documentation 
reflecting that the petitioner's work has been cited by others in their published material is 
insufficient to establish eligibility for this criterion without documentary evidence reflecting that the 
petitioner's work has been of major significance in the field. We are not persuaded that the 
moderate citations of the petitioner's articles are reflective of the significance of his work in the 
field. The petitioner failed to establish how those findings or citations of his work by others 
have significantly contributed to his field as a whole. 
Regarding the petitioner's seminars and lectures, the petitioner submitted documentary evidence 
reflecting that the petitioner participated in approximately 26 seminars, conferences, meetings, and 
lectures. We note that four of the events occurred after the filing of the petition: 
1. 
2. 
3. 
4. 
from April 
from May 7 - 8, 2009; 
Pressure Ulcer Collaborative Learning 
Session 3 - October 20 2009· and 
.. ........ - .. .... - .. .. -. .. .. .. ...... -.... - .... .. .... - .. 
Issues, Techniques, and Horizons from November 18 - 22,2009. 
5 We noted that the petitioner cited himself one time in the article, 
by the Delay Procedure." 
• .. 
" 
-Page 17 
Regardless, while the petitioner's presentations and lectures demonstrate that his work was shared 
with others and may be acknowledged as original contributions based on the selection of them to be 
presented, we are not persuaded that lecturing or presenting at various venues is sufficient evidence 
establishing that the petitioner's work is of major significance to the field as a whole and not limited 
to the engagements in which they were presented, The petitioner failed to establish, for example, 
that the presentations were of major significance so as to establish their impact or influence beyond 
the audience at the conferences. 
Without additional, specific evidence showing that the petitioner's work has been unusually 
influential or has otherwise risen to the level of contributions of major significance, we cannot 
conclude that he meets this criterion. Even considering all of the petitioner's documentary 
evidence in the aggregate, the petitioner has failed to establish that he has made original 
contributions of major significance to the field consistent with the plain language of the 
regulation at 8 C.F.R. § 204.5(h)(3)(v). 
Accordingly, the petitioner failed to establish 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. 
Although the director found that the petitioner authored articles in scientific and medical 
journals, he found that the lack of extensive citations of the petitioner's work failed to establish 
sustained national or international acclaim. The plain language of the regulation at 8 C.F.R. § 
204.5(h)(3)(vi) requires "[ e ]vidence of the alien's authorship of scholarly articles in the field, in 
professional or major trade publications or other major media." Pursuant to Kazarian, 596 F.3d at 
1122, the petitioner submitted sufficient documentation establishing that he meets the plain 
language of the regulation at 8 C.F.R. § 204.5(h)(3)(iv). Therefore, we withdraw the findings of the 
director for this criterion. 
Accordingly, the petitioner established that he meets the plain language of the regulation for this 
criterion. 
Evidence that the alien has performed in a leading or critical role for organizations 
or establishments that have a distinguished reputation. 
At the time of the original filing of the petition, the petitioner claimed eligibility for this criterion 
based on his positions with the SMC, IDF, and the Israeli Foreign Ministry (IFM). In the 
director's decision, he found that the petitioner failed to submit any documentary evidence 
regarding the distinguished reputation of SMC, and the petitioner failed to establish that he 
performed in a leading or critical role for IDF or IFM. 
The plain language of the regulation at 8 C.F.R. § 204.5(h)(3)(viii) requires "[e]vidence that the 
alien has performed in a leading or critical role for organizations or establishments that have a 
distinguished reputation [emphasis added]." In general, a leading role is evidenced from the role 
, .. 
," 
Page 18 
itself, and a critical role is one in which the alien was responsible for the success or standing of 
the organization or establishment. 
Regarding SMC, the petitioner submitted sufficient documentary evidence on appeal establishing 
the distinguished reputation of SMC. Furthermore, a review of the record of proceeding reflects 
that the petitioner submitted sufficient documentary evidence demonstrating that he has 
performed in a leading or critical role for SMC. 
Regarding IDF and IFM, counsel argues on appeal: 
Only one other physician was sent on the medical aid mISSIOns for which 
MASHAV [Foreign Ministry's Center for International Cooperation] selected [the 
petitioner]. In each case, the pair was dispatched to a Third World country with a 
local health system overwhelmed by a disaster that brought widespread injury and 
death .... In short, these missions were decidedly not "normal" volunteer trips to 
provide routine vaccinations or elective surgeries. Each addressed a full-blown, 
time-critical medical crisis that demanded the best medical representation Israel 
could provide. 
The record of proceeding reflects that the petitioner submitted the following documentation: 
1. 
2. 
3. entl from 
Hospital" reflecting an interview of the petitioner regarding the train 
collision; 
4. A letter from Cameroon thanking the 
petitioner for assisting the victims in the train collision; 
5. An article entitled, reflecting that the 
petitioner was supermarket fire; 
6. An article entitled, 
reflecting the 
7. An article entitled, reflecting that IFM 
dispatched a medical assistance team to aid the victims of the supermarket 
fire; and 
8. An article reflecting that 
the petitioner assisted the victims of the supermarket fire. 
We note that the petitioner submitted the previously mentioned and cited letter from_ 
who indicated that the petitioner "has been caring for IDF soldiers" and "has cared for IDF 
casualties who were injured in the war in Lebanon." 
, . 
0' 
Page 19 
Based on the submitted documentary evidence listed above, the petitioner demonstrated that he 
treated victims of a train wreck in Cameroon and a supermarket fire in Paraguay. While we 
admire the petitioner's humanitarian roles in these two disasters, the petitioner failed to establish 
that he has performed in a leading or critical role for IDF or IFM as a whole. We are not 
persuaded that being dispatched to two separate disasters to treat victims is demonstrative of a 
leading or critical role when compared to all of the responsibilities of IDF and IFM. For 
example, the petitioner submitted an article entitled, "MASHA V Publishes 2008 Annual Report" 
that reflects MASHA V's wide range of responsibilities from agriculture, water management, 
combating desertification, empowerment of women, entrepreneurships, health, education, 
computerization, community development, migration, and others. While the petitioner played a 
role in the routine duties of a surgical physician within IDF and IFM, the record falls far short in 
establishing that those roles were leading or critical consistent with the meaning of the plain 
language ofthe regulation at 8 C.F.R. § 204.5(h)(3)(viii). 
Although the petitioner established that he performed in a leading or critical role for SMC, the 
petitioner failed to meet the plain language of the regulation which requires leading or critical 
roles in more than one organization or establishment. In this case, the petitioner only established 
eligibility as it relates to one organization. 
Accordingly, the petitioner failed to establish that he meets this criterion. 
Evidence that the alien has commanded a high salary or other significantly high 
remuneration for services, in relation to others in the field. 
At the time of the original filing of the petition, the petitioner claimed eligibility for this criterion 
by submitting the following documentation: 
1. A letter from and 
Pensions of the Israel Medical Association, who stated: 
Regarding [the petitioner's] inquiry, we would like to inform [the 
petitioner] that according to the Ministry of Finance's 2006 report on work 
contracts and salaries, the fixed average physician salary is 9,923 New 
Israeli Shekels (NIS). Additionally, the average salary, inclusive of 
overtime and on-call shifts is 18,999 NIS. 
2. A letter from_ Certified Public Accountant, who stated: 
[The petitioner's] average (last 6 months) monthly income from his public 
position is 18,300 NIS. His average monthly income from his private 
clinic is 120,850 NIS. 
* * * 
. . .' 
-Page 20 
According to this data [the petitioner's] average monthly total income 
(139,150 NIS) is 7.6 times more than the average income for a physician 
in IsraeL 
In the director's decision, he found that the petitioner's documentary evidence failed to establish 
eligibility for this criterion, On appeal, counsel argues: 
In 2007, when Clalit, the largest of the HMO's ... began an initiative to identify 
and pay higher salaries to a select number of outstanding physicians, Haaretz 
reported the salaries of doctors employed by Clalit as unit or department heads in 
the HMO's hospitals .... According to Haaretz, the compensation level at that 
time for such physicians was 20,000 to 24,000 NIS (New Israeli Shekels) per 
month .... The same story reported that the salary of the HMO's Chief Executive 
Officer was only 60,000 NIS per month. . .. These numbers are entirely 
consistent with the figure of 18,900 NIS per month provided by [the petitioner] 
... as the average income for an Israeli physician. 
In support of the appeal, the petitioner submitted the following documentation: 
A. A screenshot from of an article entitled, "Clalit the 
About"; 
B. A screenshot from of an article entitled, "Clalit to 
Quadruple 'Star' Doctors' Pay for Giving Up Private Practices"; and 
C. A document from the Finance Ministry State Revenue Administration. 
The plain language of the regulation at 8 C.F.R. § 204.5(h)(3)(ix) requires "[e]vidence that the 
alien has commanded a high salary or other significantly high remuneration for services, in relation 
to others in the field." While to statistics from "the Ministry of Finance's 2006 
report on work contracts and petitioner failed to submit documentary evidence from 
the Ministry of Finance in order to support the claims o~ Furthermore,_ 
referred to the "average" salary of physicians. However, as the plain language of the regulation 
requires the petitioner to establish that his salary is high when compared to others in the field, 
average salary statistics do not meet this requirement. 
Moreover, while the petitioner submitted a letter from his certified public accountant, we note 
that the petitioner failed to submit any supporting evidence such as his tax returns or pay stubs 
for his public position. Nevertheless, indicated that the petitioner's average salary for 
six months was NIS 18,300, which is NIS 600 less than the average salary stated by_. 
_ failed to specify if the average salary from the petitioner's public position included 
overtime or on-call. Furthermore, the screenshot from reflects that "the 
average salaries of a unit or department head at one of the hospitals is in the neighborhood of 
NIS 20,000 - 24,000 a month." Notwithstanding that the article refers to the average salaries of 
a unit or department head, the petitioner's average salary for his public position is NIS 18,300, 
which is less than the average salaries in the article. 
• • • 
" 
-Page 21 
While _ stated that the petitioner earned NIS 120,850 from his private clinic, the 
petitioner failed to offer any documentary evidence of salaries of physicians who operate private 
clinics. Again, as the petitioner failed to submit the documentation from the Finance of Ministry 
regarding the 2006 report on work contracts and salaries, we are unable to compare the 
petitioner's salary from his private clinic to others in his field. 
We note, regarding item C, that counsel claimed that the document from the Finance Ministry 
State Revenue Administration reflected that "[t]he assessment is for [the petitioner's] private 
practice only, D.J.T. (Dorit [the petitioner's] spouse) Medicine." Notwithstanding that the 
document appears to reflect the revenue/loss of the clinic and not the salary of the petitioner, a 
review of the document reflects that the business lost NIS 382,976. 
For the reasons stated above, the petitioner failed to establish that his salary is high in relation to 
others in the field. 
Accordingly, the petitioner failed to establish that he meets this criterion. 
B. Final Merits Determination 
In accordance with the Kazarian opinion, we must next conduct a final merits determination that 
considers all of the evidence in the context of whether or not the petitioner has demonstrated: (1) 
a "level of expertise indicating that the individual is one of that small percentage who have risen 
to the very top of the[ir] field of endeavor," 8 C.F.R. § 204.5(h)(2); and (2) "that the alien has 
sustained national or international acclaim and that his or her achievements have been 
recognized in the field of expertise." See section 203(b)(1)(A)(i) of the Act, 8 U.S.C. 
§ 1153(b)(1)(A)(i), and 8 C.F.R. § 204.5(h)(3). See also Kazarian, 596 F.3d at 1115. The 
petitioner established eligibility for one of the criteria, in which at least three are required under 
the regulation at 8 C.F.R. § 204.5(h)(3). In this case, many of the deficiencies in the 
documentation submitted by the petitioner have already been addressed in our preceding 
discussion of the regulatory criteria at 8 C.F.R. § 204.5(h)(3). 
In evaluating our final merits determination, we must look at the totality of the evidence to 
conclude the petitioner's eligibility pursuant to section 203(b)(1 )(A) of the Act. In this case, the 
petitioner has demonstrated that he has authored some scholarly articles, garnered some attention 
from his colleagues, and performed in a leading or critical role for a single establishment. 
However, the accomplishments of the petitioner fall far short of establishing that he "is one of that 
small percentage who have risen to the very top of the field of endeavor" and that he "has 
sustained national or international acclaim and that his or her achievements have been 
recognized in the field of expertise." See 8 C.F .R. § 204.5(h)(2), section 203(b)(1 )(A)(i) of the 
Act, 8 U.S.c. § 1 1 53 (b)(1)(A)(i), and 8 C.F.R. § 204.5(h)(3). 
The regulation at 8 C.F.R. § 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." The 
• • 
-Page 22 
petitioner's evidence must be evaluated in terms of these requirements. The weight given to 
evidence submitted to fulfill the criteria at 8 C.F.R. § 204.5(h)(3), therefore, depends on the 
extent to which such evidence demonstrates, reflects, or is consistent with sustained national or 
international acclaim at the very top of the alien's field of endeavor. A lower evidentiary 
standard would not be consistent with the regulatory definition of "extraordinary ability" as "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. § 204.5(h)(2). 
Moreover, while the petitioner demonstrated eligibility for the scholarly articles criterion 
pursuant to the regulation at 8 C.F.R. § 204.5(h)(3)(vi), the record reflects that the petitioner 
submitted evidence of having authored 14 scholarly articles. However, when compared to the 
authorship of those who submitted recommendation letters on the petitioner's behalf and those 
who cited the petitioner's work, the accomplishments of the petitioner are in stark contrast. For 
example: 
1. 
2. 
3. 
4. 
5. 
books; and 
authored 56 peer-reviewed publications; 
authored 72 articles; 
authored 66 articles; 
authored 35 articles, three book chapters, and two 
authored 82 articles. 
Moreover, while the petitioner submitted evidence of moderate citation of his work by others, we 
are not persuaded that such a citation rate demonstrates the sustained national or international 
acclaim required for this highly restrictive classification. As authoring scholarly articles is 
inherent to scientific research, we will evaluate a citation history or other evidence of the impact 
of the petitioner's articles when determining their significance to the field. For example, 
numerous independent citations for an article authored by the petitioner would provide solid 
evidence that other researchers have been influenced by his work and are familiar with it. Such 
an analysis at the final merits determination stage is appropriate pursuant to Kazarian, 596 F. 3d 
at 1122. On the other hand, few or no citations of an article authored by the petitioner may 
indicate that his work has gone largely unnoticed by others in his field. The petitioner submitted 
evidence showing that his body of work has been independently cited 103 times. As indicated 
previously, the petitioner's two most cited articles were cited 32 and 15 times each. While these 
citations demonstrate some interest in his published articles, they are not sufficient to 
demonstrate that his articles have attracted a level of interest in his field commensurate with 
sustained national or international acclaim. We note again that the majority of the articles 
authored by the petitioner were cited less than ten times, with four articles cited once or twice, 
and no evidence that two of the petitioner's articles were ever cited. 
While the petitioner failed to establish eligibility under the leading or critical role criterion 
pursuant to the regulation at 8 C.F.R. § 204.5(h)(3)(viii), the petitioner submitted evidence 
reflecting eligibility as it pertained to one establishment, of which more than one is required. 
Even comparing the petitioner's role with SMC to the role who is the Director of 
• • • . . .. 
Page 23 
SMC, the petitioner falls far short in demonstrating that he "is one of that small percentage who 
have risen to the very top of the field of endeavor" and that he "has sustained national or 
international acclaim and that his or her achievements have been recognized in the field of 
expertise." See 8 C.F.R. § 204.5(h)(2), section 203(b)(1)(A)(i) of the Act, 8 U.S.C. 
§ 1153(b)(1)(A)(i), and 8 C.F.R. § 204.5(h)(3). We note that although the petitioner claimed 
eligibility based on his routine duties as a physician with IDF, this is in stark contrast to the role 
o~ who is the Surgeon General of the IDF. 
Although the petitioner submitted recommendation letters praising the petitioner, such letters 
cannot form the cornerstone of a successful extraordinary ability claim. Further, USCIS may, in 
its discretion, use as advisory opinion statements submitted as expert testimony. See Matter of 
Caron International, 19 I&N Dec. at 795. However, USCIS is ultimately responsible for making 
the final determination regarding an alien's eligibility for the benefit sought. Id. The submission 
of letters of support from the petitioner's personal contacts 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. 
We also cannot ignore that the statute reqmres the petItIOner to submit "extensive 
documentation" of the petitioner's sustained national or international acclaim. See section 
203(b)(1)(A) of the Act. The commentary for the proposed regulations implementing section 
203(b )(1 )(A)(i) of the Act provide that the "intent of Congress that a very high standard be set for 
aliens of extraordinary ability is reflected in this regulation by requiring the petitioner to present 
more extensive documentation than that required" for lesser classifications. 56 Fed. Reg. 30703, 
30704 (July 5, 1991). While the petitioner failed to establish eligibility under the salary criterion 
pursuant to the regulation at 8 C.F.R. § 204.5(h)(3)(ix), the petitioner failed to submit extensive 
documentation of his eligibility for the criterion. Specifically, the petitioner failed to submit 
primary evidence of his salary as a physician in a public position and the salary earned based on 
his private clinic and not the revenue/loss of the clinic as a whole. Furthermore, the petitioner 
failed to submit sufficient documentary evidence demonstrating that his salary is high compared 
to others in his field. 
The petitioner failed to submit evidence demonstrating that he "is one of that small percentage who 
have risen to the very top of the field." In addition, the petitioner has not demonstrated his "career 
of acclaimed work in the field" as contemplated by Congress. H.R. Rep. No.1 0 1-723, 59 (Sept. 19, 
1990). 
The conclusion we reach by considering the evidence to meet each criterion separately is consistent 
with a review of the evidence in the aggregate. Even in the aggregate, the evidence does not 
distinguish the petitioner as one of the small percentage who has risen to the very top of the field of 
endeavor. 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. 
III. 0-1 Nonimmigrant Admission 
.. . .. .. 
Page 24 
We note that the petitioner submitted documentary evidence reflecting that he was approved for 
at least two 0-1 nonimmigrant visas. However, while USCIS has approved at least two 0-1 
nonimmigrant visa petitions filed on behalf of the petitioner, the prior approvals do not preclude 
USCIS from denying a subsequently filed immigrant visa petition. It must be noted that many 1-
140 immigrant petitions are denied after USCIS approves prior nonimmigrant petitions. See, 
e.g., Q Data Consulting, Inc. v. INS, 293 F. Supp. 2d 25 (D.D.C. 2003); IKEA US v. US Dept. of 
Justice, 48 F. Supp. 2d 22 (D.D.C. 1999); Fedin Brothers Co. Ltd. v. Sava, 724 F. Supp. 1103 
(E.D.N.Y. 1989). Because USCIS spends less time reviewing 1-129 nonimmigrant petitions than 
1-140 immigrant petitions, some nonimmigrant petitions are simply approved in error. Q Data 
Consulting, Inc. v. INS, 293 F. Supp. 2d at 29-30; see also Texas A&M Univ. v. Upchurch, 99 
Fed. Appx. 556,2004 WL 1240482 (5th Cir. 2004) (finding that prior approvals do not preclude 
USCIS from denying an extension of the original visa based on a reassessment of petitioner's 
qualifications). 
The AAO is not required to approve applications or petitions where eligibility has not been 
demonstrated, merely because of prior approvals that may have been erroneous. See, e.g., Matter 
of Church Scientology International, 19 I&N Dec. at 597. It would be absurd to suggest that 
USCIS or any agency must treat acknowledged errors as binding precedent. Sussex Engg. Ltd. v. 
Montgomery, 825 F.2d at 1090. 
Furthermore, the AAO's authority over the service centers is comparable to the relationship 
between a court of appeals and a district court. Even if a service center director had approved 
the nonimmigrant petitions on behalf of the beneficiary, the AAO would not be bound to follow 
the contradictory decision of a service center. Louisiana Philharmonic Orchestra v. INS, 2000 
WL 282785 (E.D. La.), affd, 248 F.3d 1139 (5th Cir. 2001), cert. denied, 122 S.Ct. 51 (2001). 
An application or petition that fails to comply with the technical requirements of the law may be 
denied by the AAO even if the Service Center does not identify all of the grounds for denial in 
the initial decision. See Spencer Enterprises, Inc. v. United States, 229 F. Supp. 2d at 1043, 
affd, 345 F.3d at 683; see also Soltane v. DOJ, 381 F.3d at 145 (noting that the AAO conducts 
appellate review on a de novo basis). 
IV. Conclusion 
Review of the record does not establish that the petitioner has distinguished himself to such an 
extent that he may be said to have achieved sustained national or international acclaim and to be 
within the small percentage at the very top of his field. The evidence is not persuasive that the 
petitioner's achievements set him significantly above almost all others in his field at a national or 
international level. Therefore, the petitioner has not established eligibility pursuant to section 
203(b)(1)(A) of the Act, and the petition may not be approved. 
The petition will be denied for the above stated reasons, with each considered as an independent 
and alternative basis for denial. In visa petition proceedings, the burden of proving eligibility for 
• • 
-Page 25 
the benefit sought remains entirely with the petitioner. Section 291 of the Act, 8 U.S.C. § 1361. 
Here, that burden has not been met. 
ORDER: The appeal is dismissed.