sustained EB-1A Case: Nephrology

U.S. Citizenship 
and Immigration 
Services 
In Re : 17513961 
Appeal of Nebraska Service Center Decision 
Non-Precedent Decision of the 
Administrative Appeals Office 
Date: AUG. 24 , 2021 
Form I-140, Immigrant Petition for Alien Worker (Extraordinary Ability) 
The Petitioner , a nephrologist , seeks classification as an individual of extraordinary ability . See 
Immigration and Nationality Act (the Act) section 203(b)(l)(A) , 8 U .S.C. § 1153(b)(l)(A) . This first 
preference classification makes immigrant visas available to those who can demonstrate their 
extraordinary ability through sustained national or international acclaim and whose achievements have 
been recognized in their field through extensive documentation. 
The Director of the Nebraska Service Center denied the petition , concluding that although the record 
established that the Petitioner satisfied the initial evidentiary requirements for this classification , it did 
not demonstrate, as required, that he has sustained national or international acclaim and is among the 
small percentage at the very top of his field. The matter is now before us on appeal. 
In these proceedings , it is the Petitioner's burden to establish eligibility for the requested benefit by a 
preponderance of the evidence. Section 291 of the Act, 8 U.S.C . § 1361 ; Matter ofChawath e, 25 I&N 
Dec. 369 , 375 (AAO 2010) . Upon de nova review , we will sustain the appeal. 
I. LAW 
Section 203(b)(l)(A) of the Act makes immigrant visas available to aliens with extraordinary ability 
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. 
The term "extraordinary ability" refers only to those individuals in "that small percentage who have 
risen to the very top of the field of endeavor." 8 C.F.R. § 204.5(h)(2). The implementing regulation 
at 8 C.F.R. § 204.5(h)(3) sets forth a multi-part analysis. First, a petitioner can demonstrate 
international recognition of his or her achievements in the field through a one-time achievement (that 
is, a major, internationally recognized award). If the petitioner does not submit this evidence, then he 
or she must provide sufficient qualifying documentation that meets at least three of the ten criteria 
listed at 8 C.F.R. § 204.5(h)(3)(i)---{x) (including items such as awards, published material in certain 
media, and scholarly articles). 
Where a petitioner meets these initial evidence requirements, we then consider the totality of the 
material provided in a final merits determination and assess whether the record shows sustained 
national or international acclaim and demonstrates that the individual is among the small percentage 
at the very top of the field of endeavor. See Kazarian v. USCJS, 596 F.3d 1115 (9th Cir. 2010) 
( discussing a two-part review where the documentation is first counted and then, if fulfilling the 
required number of criteria, considered in the context of a final merits determination); see also 
Visinscaia v. Beers, 4 F. Supp. 3d 126, 131-32(D.D.C. 20l3);Rijalv. USCIS, 772 F. Supp. 2d 1339 
(W.D. Wash. 2011). 
II. ANALYSIS 
The Petitioner is a physician and clinical researcher in the internal medicine specialty of nephrology. 
At the time of filing, he was an attending physician, faculty member, and director of clinical research 
for the Division of Nephrology atl I inl I 
A. Evidentiary Criteria 
Because the Petitioner has not indicated or established that he has received a major, internationally 
recognized award, he must satisfy at least three of the alternate regulatory criteria at 
8 C.F.R. § 204.5(h)(3)(i)---{x). 
The Director concluded that the Petitioner met three of these ten criteria and the record supports this 
determination. The Petitioner's documented service as a peer reviewer for professional journals 
constitutes participation as a judge of the work of others in the same or allied field under 8 C.F.R. 
§ 204.5(h)(3)(iv). The Petitioner has also authored scholarly articles in professional publications in 
his field and therefore meets the criterion at 8 C.F.R. § 204 .5(h)(3 )(vi). Finally, the record establishes 
that the Petitioner has served in critical roles for thel I Health system and demonstrates 
that his employer enjoys a distinguished reputation among U.S. medical institutions, thus satisfying 
the criterion at 8 C.F.R. § 204.5(h)(3)(viii). Because the Petitioner has established that he meets the 
initial evidence requirements, we will discuss the totality of the evidence, including evidence 
submitted in support of additional criteria at 8 C.F.R. § 204.5(h)(3)(i)-(x), in the final merits 
determination below. 
B. Final Merits Determination 
As the Petitioner submitted the requisite initial evidence, we will evaluate whether he has 
demonstrated, by a preponderance of the evidence, that he has sustained national or international 
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acclaim and that he is one of the small percentage at the very top of the field of endeavor, and that his 
achievements have been recognized in the field through extensive documentation. In a final merits 
determination, we analyze a petitioner's accomplishments and weigh the totality of the evidence to 
determine if their successes are sufficient to demonstrate that they have extraordinary ability in the 
field of endeavor. See section 203(b)(l)(A)(i) of the Act; 8 C.F.R. § 204.5(h)(2), (3); see also 
Kazarian, 596 F.3d at 1119-20. We conclude that the Petitioner has demonstrated his eligibility for 
this classification. 
The record reflects that the Petitioner completed his initial medical training in India, where he received 
a bachelor of medicine and bachelor of surgery MBBS from! I University in 2000 and a doctor 
of medicine (MD) degree from University o in 2006. Subse uentl , he com leted an 
internship and residency in internal medicine at.__ _______________ __.between 
2008 and 2011, where he served as the chief medical resident in internal medicine from 2011 until 
2012. The Petitioner received his certification in nephrology from the American Board of Internal 
Medicine in November 2014 after completing a two-year fellowship at University ofl I at 
I I He currently serves as an attending physician, faculty member and director of clinical 
research inl l's Division of Nephrology. The record reflects that, since receiving 
his board ce1iification, the Petitioner has been able to achieve and sustain a national reputation as an 
expe1i in the research and treatment of rare kidney diseases and, more recently, in the treatment of 
COVID-19-related kidney injury. 
With respect to his experience judging the work of others, the Petitioner established that he has 
received and completed independent requests to review a substantial number of manuscripts for 
renowned professional publications. We find the Petitioner's judging experience, together with the 
achievements described further below, to be consistent with a dete1mination that he is among the small 
percentage at the top of his field of endeavor. See 8 C.F.R. § 204.5(h)(2). 
As noted, the Petitioner provided evidence that he serves in a critical role as an attending physician 
and director of clinical research in nephrology forl ~ al I hospital 
system. The record reflects that this prominent position has provided the Petitioner with opportunities 
to participate in high-profile clinical research consortia which have, in tum, garnered him wider 
reco ition as a leading expert in his field. Of note the Petitioner was invited to artici ate as 
s site investi atorforth _,___......------------.-------.--,-----,,------' 
'-------------~· The coordinator of this study.__ ____ ___,of Medical 
School, describes it as a multidisciplinary, multi-institutional study that was created 
0".__ __ _,emphasizes that while over 300 investi ators are involved in the.__ ____ _, study, 
the Petitioner was invited to join the grou 's committee, which is comprised of a much 
smaller team of researchers. As such,,..__ _ ___, states that the Petitioner should be considered a main 
author of several major studies that significantly impact the treatment of COVID-19 in critically ill 
patients. 
The record contains evidence that the Petitioner's co-authored article, 
.__ ______________________________ _,' published in 
JAMA Internal Medicine, received major media attention upon publication from outlets that included 
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NPR, The Washington Post, BBC, USA Today and CNN. Further, the record reflects that the drug 
tocilizumab has since been approved by health authorities in the United Kingdom and elsewhere as a 
viable treatment option for critically ill COVID-19 patients. 
A letter frou_,_ __ ~--~-------_.American Society ofN ephrology (ASN), explains 
ificance of the Petitioner's paper ·j I 
'----......---.---------.-------.....,..... which was published in the Journal of the American Society of 
Nephrology (JASN). ~-~-~emphasizes that this research represents "the largest and most 
influential study of COVID-19 patients admitted to ICU who needed dialysis, and is invaluable to 
physicians, public health professionals and hospital administrators to anticipate the need for dialysis 
in critically ill patients with COVID-19 and ... to ensure adequate dialysis facilities and trained 
personnel."I ,IChief of the Division ofNephrology at University~------~ 
also discusses this "seminal article," noting that it served to "increase our understanding of the 
intersection between COVID-19 and AKI [ acute kidney injury] and guides treatment decisions by 
clinical physicians as we navigate this deadly pandemic about which know very little." In addition. 
the record reflects that ASN invited the Petitioner to present the study at its annuall I 
conference and that the editor-in-chief of JASN highlighted this article as one of the five most 
important studies published by the journal in 2020. 
Collectively, the expert opinion testimony in the record indicates that the Petitioner's high-profile 
research wit~ I has resulted in him becoming recognized as "one of the leading experts 
on how nef hrology intersects with COVID-19." In recognition of this expertise, the Petitioner was 
invited by 11 to generate and publish its official COVID-19 
guidelines for N ephrotic Synd.ro~S) patients, a population that is at higher risk of death from the 
diseaseJ ICEO o±l_J states that the guidelines developed by the Petitioner have been 
accessed by patients and practitioners thousands of times. 
In his role as director of clinical research at the Petitioner also serves as a 
principal site investigator and steering committee member of the '-------~-~------' 
I I I I is a multi-site research consmiium, funded by and the 
I I that aims to understand and advance treatments for nephrotic syndrome 
diseases. The record reflects that the Petitioner's contributions to the I , u , I group's published 
research have garnered him national recognition as a leading expert in the clinical research and 
treatment of NS. In this regard, the Petiti~ner provided evidence that he is one of a small number of 
nephrologists who has been designated b as a.__ ___________ __.' The record, 
which has been supplemented on appeal, includes ample evidence that practicing nephrologists, 
clinical researchers and phannaceutical companies recognize the Petitioner as a leading specialist in 
this field and have independently sought the Petitioner's expertise and collaboration on both the 
research and treatment of NS and other rare kidney diseases. The0' s states that the 
Petitioner was invited to presento~ ts activities at the organization's 2019 
I I and emphasizes that he is regarded in the field as a "leading voice in~a-dv_o_c_a_t-in_g_fo~r 
kidney research." 
is described as "the onl or anization committed exclusively to accelerate research for effective treatment for 
.__ _______________ ___, and provide education and support that will improve the lives of 
those affected." 
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The record reflects that several of the Petitioner's other clinical research contributions have been 
highlighted in significant ways that have garnered him additional recognition in his field and which 
set him apart from other practicing nephrologists. For example, several of the expert recommendation 
letters submitted in support of the petition comment on the importance of the Petitioner's article 
which was published in BMC 
~N:_e_p_h-ro_l_o_g_y_a_n_d_w_a_s -th_e_s-,u-b-de_c_t_o_f_a_f_e_a_tu_r_e_a-1i-ic--l-e-in-th_e_A_S_N_p_u_b_li~cation Kidney News in 2020 .D 
.__ _____ ____. a professor at University ofl I ex~lains that kidney biopsy, 
while essential to advancing research of kidney diseases, is associated witht !complications, 
making it important to find interventions that reducel I risks. He states that the Petitioner's 
publication, which provides guidance on the safe and effective administration ofl I during 
biopsy "received significant attention amongst nephrologists and s ecialists working in allied fields." 
I I similarly describes the Petitioner's article on the use of in kidney biopsy as 
"practice changing research" in the field of clinical nephrology . .__ ___ ____.also discusses this 
research in his letter, noting that '"[d]ue to the significance of [the Petitioner's] publication on 
I Ito allnephrologists, we also used itin one ofASN's main educational tools, the "Kidney 
Self-Assessment Program" (KSAP), which "reviews the essentials of nephrology" for those preparing 
for board certification and re-certification in the field. 
~-----~[ an associate rofessorofmedicine atUniversi o 
the Petitioner's 2019 article 
em hasizes that 
~------~-----~ has been cited in UPTODA TE, which he describes as "a clinical 
design support resource relied on by hundreds of thousands of physicians to improve patient 
outcomes." I I explains that the Petitioner's was the first research study investigating the 
incidence of severe acute kidney injury among civilian I !victims and includes 
recommendations for recognizing and managing kidney injury among this population to ensure better 
patient outcomes. I l's letter also discusses the inclusion of the Petitioner's study in 
UPTODA TE, noting that the article now serves as "a valuable resource for every nephrologist and 
I lwho cares for adult patients withl I injuries in the United States." 
Overall, the evidence related to the Petitioner's research contributions shows that his work has 
consistently been recognized for its significance, either in major media, by professional organizations 
and publications, and by inclusion in resources that physicians rely on to make clinical decisions 
regarding the treatment of patients with kidney injury or disease. These contributions are discussed 
in detail by experts who explain the influence of the Petitioner's work on both research and clinical 
practice, and who confirm that his collective contributions have resulted in his recognition as "one of 
the top nephrologists practicing today." 
Finally, although many of the Petitioner's scholarly articles, and particularly those in which he applied 
his expertise to COVID-19 research, are quite recent, he offered a Google Scholar report reflecting a 
substantial number of citations to his published work. Further, the record reflects that he continues to 
publish scholarly articles in distinguished professional journals and is consistently invited as a 
presenter at the major conferences in his field of expertise. 
When considered in the aggregate with the evidence discussed above, the Petitioner has demonstrated 
that his achievements are reflective of a "career of acclaimed work in the field" as contemplated by 
Congress. H.R.Rep.No.101-723,59(Sept.19, 1990). Weconcludethattherecordsuppmisafinding 
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that the Petitioner is among the small percentage at the top of his field of endeavor with sustained 
national or international acclaim. See 8 C.F.R. § 204.5(h)(2)-(3). 
III. CONCLUSION 
The Petitioner has shown that he meets at least three of the evidentiary criteria listed at 8 C.F.R. 
§ 204.5(h)(3)(i)-(x). He has also demonstrated sustained national and international acclaim and that 
his achievements have been recognized through extensive documentation. Lastly, the Petitioner has 
shown that he intends to continue working in his area of expertise and that his work will substantially 
benefit the United States. He therefore qualifies for classification as an individual of extraordinary 
ability. 
ORDER: The appeal is sustained. 
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