dismissed EB-2 NIW Case: Cardiology

MATTER OF A-R-A-A-E-
Non-Precedent Decision of the 
Administrative Appeals Office 
DATE: MAY 10,2017 
APPEAL OF NEBRASKA SERVICE CENTER DECISION 
PETITION: FORM 1-140, IMMIGRANT PETITION FOR ALIEN WORKER 
The Petitioner, a physician and researcher specializing in cardiology, seeks second preference 
immigrant classification as a member of the professions holding an advanced degree, as well as a 
national interest waiver of the job offer requirement attached to this EB-2 classification. See 
Immigration and Nationality Act (the Act) section 203(b)(2), 8 U.S.C. § 1153(b)(2). After a 
petitioner has established eligibility for EB-2 classification, U.S. Citizenship and Immigration 
Services (USCIS) may, as matter of discretion, grant a national interest waiver if the petitioner 
demonstrates: (1) that the foreign national's proposed endeavor has both substantial merit and 
national importance; (2) that the foreign national is well positioned to advance the proposed 
endeavor; and (3) that, on balance, it would be beneficial to the United States to waive the 
requirements of a job offer and thus of a labor certification. Matter of Dhanasar, 26 I&N Dec. 884 
(AAO 2016). 
The Director of the Nebraska Service Center denied the Form I-140, Immigrant Petition for Alien 
Worker, finding that the Petitioner qualified for classification as a member ,of the professions 
holding an advanced degree, but that he had not established that a waiver of a job offer, and thus of a 
labor certification, would be in the national interest. The matter is now before us on appeal. 
In February 2017, we issued a request for evidence (RFE) asking the Petitioner to provide evidence 
satisfying the three-part framework set forth in Dhanasar. In response, the Petitioner submits 
additional documentation and contends that he is eligible for a national interest waiver under the 
Dhanasar framework. 
Upon de novo review, we will dismiss the appeal. 
I. LAW 
To establish eligibility for a national interest waiver, a petitioner must first demonstrate qualification 
for the underlying EB-2 visa classification, as either an advanced degree professional or an 
individual of exceptional ability in the sciences, arts, or business. Because this classification 
requires that the individual's services be sought by a U.S. employer, a separate showing is required 
to establish that a waiver of the job offer requirement is in the national interest. 
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Section 203(b) of the Act sets out this sequential framework: 
(2) Aliens who are members of the professions holding advanced degrees or aliens of 
exceptional ability.-
(A) In general. - Visas shall be made available ... to qualified immigrants who 
are members of the professions holding advanced degrees or their equivalent or 
who because of their exceptional ability in the sciences, arts, or business, will 
substantially benefit prospectively the national economy, cultural or educational 
interests, or welfare of the United States, and whose services in the sciences, arts, 
professions, or business are sought by an employer in the United States. 
(B) Waiver of job offer-
(i) National interest waiver. ... the Attorney General may, when the Attorney 
General deems it to be in the national interest, waive the requirements of 
subparagraph (A) that an alien's services in the sciences, arts, professions, or 
business be sought by an employer in the United States. 
While neither the statute nor the pertinent regulations define the term "national interest," we recently 
set forth a new framework for adjudicating national interest waiver petitions. See Dhanasar, 26 I&N 
Dec. 884.1 Dhanasar clarifies that, after EB-2 eligibility as an advanced degree professional or 
individual of exceptional ability has been established, USCIS may grant a national interest waiver if 
the petitioner demonstrates by a preponderance of the evidence: (1) that the foreign national's 
proposed endeavor has both substantial merit and national importance; (2) that the foreign national is 
well positioned to advance the proposed endeavor; and (3) that, on balance, it would be beneficial to 
_ the United States to waive the requirements of a job offer and thus of a labor certification. If these 
three elements are satisfied, USCIS may approve the national interest waiver as a matter of 
discretion. 
The first prong, substantial merit and national importance, focuses on the specific endeavor that the 
foreign national proposes to undertake. The endeavor's merit may be demonstrated in a range of 
areas such as business, entrepreneurialism, science, technology, culture, health, or education. In 
determining whether the proposed endeavor has national importance, we consider its potential 
prospective impact. 
The second prong shifts the focus from the proposed endeavor to the foreign national. To determine 
whether he or she is well positioned to advance the proposed endeavor, we consider factors 
including, but not limited to: the individual's education, skills, knowledge and record of success in 
related or similar efforts; a model or plan for future activities; any progress towards achieving the 
1 
In announcing this new framework, we vacated our prior precedent decision, Matter of New York State Department of 
Transportation, 22 I&N Dec. 215 (Act. Assoc. Comm 'r 1998) (NYSD01). 
2 
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prop<;>sed endeavor; and the interest of potential customers, users, investors, or other relevant entities 
or individuals. 
The third prong requires the petitioner to demonstrate that, on balance, it would be beneficial to the 
United States to waive the requirements of a job offer and thus of a labor certification. In 
performing this analysis, USC IS may evaluate factors such as: whether, in light of the nature of the 
foreign national's qualifications or the proposed endeavor, it would be impractical either for the 
foreign national to secure a job offer or for the petitioner to obtain a labor certification; whether, 
even assuming that other qualified U.S. workers are available, the United States would still benefit 
from the foreign national's contributions; and whether the national interest in the foreign national's 
contributions is sufficiently urgent to warrant forgoing the labor certification process. In each case, 
the factor(s) considered must, taken together, indicate that on balance, it would be beneficial to the 
United States to waive the requirements of a job offer and thus of a labor certification. 2 
II. ANALYSIS 
The Director found that the Petitoner qualifies as a member of the professions holding an advanced 
degree. The sole issue to be determined is whether the Petitioner has established that a waiver of the 
requirement of a job offer, and thus a labor certification, would be in the national interest. 
At the time of filing, the Petitioner was pursuing postgraduate medical training as a general 
cardiology fellow at the In response to our RFE, 
he submits a June 2016 letter of~ering him "a position as a fellow in our 
at This letter states that the Petitioner's "fellowship is one year in 
length, and your training will begin on July 1, 2017 and be completed on June 30, 2018." 
A. Substantial Merit and National Importance of the Proposed Endeavor 
The Petitioner previously stated that his clinical work offering quality healthcare "has an effect on 
the health care system of the United States as a whole" and that his "medical research is having a 
widespread impact on the quality of medical care across the United States." In a letter of support, 
professor of cardiology at stated "As a cardiologist, [the Petitioner] treats 
and does research on a wide range of heart conditions, including systolic heart failure, which 
constitutes about 50% of heart failure cases. This amounts to 2.5 million patients in the United 
States ... and it is a major cause of morbidity and mortality." Whether as a physician or researcher, 
we find that the Petitioner's proposed work as a cardiologist has substantial merit. 
2 ! 
See Dhanpsar, 26 I&N Dec. at 888-91, for elaboration on these three prongs. 
3 He previously completed an advanced heart failure and transplant cardiology fellowship at the 
and Prior to that, he served as an internal medicine resident at 
4 As the Petitioner is applying for a waiver of the job offer requirement, it is not necessary for him to have a job offer 
from a specific employer. However, we will consider information about this prospective position to illustrate the 
capacity in which he intends to work. 
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With respect to the national importance of the Petitioner's proposed endeavor, our RFE asked for 
evidence documenting the "potential prospective impact" ofhis work. The Petitioner's response states 
that "[a]s a share of the nation's Gross Domestic Product [GDP], health spending accounted for 17.8 
percent of U.S. GDP, so [the Petitioner's] contributions as both a clinician and a researcher are 
undoubtedly of national importance." He further indicates that his clinical work "saving the lives of 
sick patients" offers such a valuable contribution to the nation "that it cannot be statistically 
quantified, as he is responsible for the precious health and lives of countless U.S. citizens." While 
the Petitioner's care and treatment of patients have substantial merit, the record does not establish 
that his clinical work would impact the cardiology field and healthcare industry more broadly, as 
opposed to being limited to the patients he serves. Accordingly, without sufficient documentary 
evidence of its broader impact, the Petitioner's clinical work as a physician and cardiologist does not 
meet the "national importance" element of the first prong of the Dhanasar framework.5 
Nonetheless, the Petitioner's response attests that the national importance of his work "is primarily 
demonstrated by the research he has done and is continuing to do, as evidence [sic] by his multiple 
publications .... " To the extent that the Petitioner proposes to conduct cardiology research, we find 
the evidence sufficient to demonstrate that such research is of national importance. For example, the 
record includes letters from physicians and professors of medicine discussing his research 
concerning heart conditions and its potential benefit to our nation's healthcare system. In addition, 
the Petitioner has submitted documentation indicating that the proposed benefit of his cardiology 
research has broader implications, as the results from his work are disseminated to others in the field 
through medical journals and conferences. As the Petitioner has documented both the substantial 
merit and national importance of his proposed research, he meets the first prong of the Dhanasar 
framework. 
B. Well Positioned to Advance the Proposed Endeavor 
The second prong shifts the focus from the proposed endeavor to the Petitioner's qualifications. The 
Petitioner previously submitted documentation of his published work, conference presentations, 
professional memberships, academic credentials, and internal awards from He also offered 
various reference letters discussing his medical training and research projects. In response to our 
RFE, the Petitioner additionally provides his curriculum vitae (CV), further publications and 
presentations, medical credentials, and emails inviting him to publish and present his work. 
As discussed below, the Petitioner has not demonstrated a record of success or progress in his field, or a 
degree of interest in his work from relevant parties, that rises to the level of rendering him well 
positioned to advance his proposed research endeavor of understanding unique heart conditions and 
identifying proper methods of diagnosis and treatment.6 See Dhanasar, 26 I&N Dec. at 890. The 
5 Similarly, in Dhanasar, we determined that the petitioner's teaching activities did not rise to the level of having 
national importance because they would not impact his field more broadly. !d. at 893. 
6 As noted above, the Petitioner has not demonstrated that his proposed clinical activities as a physician meet the 
"national importance" element of the Dhanasar framework's first prong. Accordingly, we will limit our analysis under 
4 
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Matter of A-R-A-A-E-
Petitioner maintains that he has "provided substantial evidence of [his] achievements, including 
letters of support" and that the record shows his work "is having a substantial impact on medical 
care in the United States." 
In letters supporting the petition, various medical professors discussed the Petitioner's research 
aimed at understanding rare cardiac conditions. For exan{ple, professor of 
pediatrics at stated that the Petitioner "was able to demonstrate, by 
coronary angiography, for the first time in the medical literature that coronary flow impairment can 
be secondary to not only atherosclerosis, but also compression from the outside such as pericardia! 
effusion." 7 indicated that the Petitioner's findings provided his peers "with a better 
understanding of effusive constrictive pericarditis so that they could put this valuable knowledge to 
practice in their own institutions across the United States and around the world." Similarly 
. assistant professor of medicine at indicated that the 
Petitioner performed "a very interesting study on cardiac catheterization and coronary angiography 
that addresses the differences between performing these procedures by assessing the heart via the 
femoral artery ... and the radial artery .... " He further noted that this study "produced a wealth of 
data and some very promising conclusions about the trans-radial approach, which has been shown to 
have higher patient satisfaction, less bleeding, and shorter hospital stays." The letters from 
and do not, however, provide specific examples of how the Petitioner's 
findings have generated positive interest among relevant parties, have been implemented at medical 
institutions, or otherwise reflect a record of success in his area of research. 
assistant professor at discussed two of the 
Petitioner's recent medical case reports. He noted that the Petitioner's first paper described a case 
involving an endomyocardial biopsy with a coronary-cameral fistula <;tnd that his second paper 
reported on a case involving left main coronary artery spasm. In addition, asserted 
that the Petitioner's reports will offer useful guidelines to physicians faced with similar medical 
cases. While the record reflects that the aforementioned case reports were submitted for publication, 
the evidence does not show that they had been published at the time of filing the Form 1-140 on June 
18, 2015, or that his findings had drawn the interest of relevant individuals or entities prior to 
publication. Eligibility must be established at the time of filing. 8 C.F.R. § 103.2(b)(l), (12). 
Two references from offer further examples of the Petitioner's research that was published 
or presented after the petition's filing date. For instance, professor and chief of 
cardiology, indicated that the Petitioner recently performed a study that examined "the mortality anp 
cost of hospitalized patients with acute and chronic diastolic heart failure in the United States." 8 
Additionally, the response to our RFE includes a March 2017 letter from 
this prong to his proposed research. 
7 The Petitioner's research was presented at the 
(20 12). 
0 
~ According to his CV, the Petitioner presented this work at the 
2016. 
5 
in 
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professor and chief of the division of cardiovascular medicine, stating that the Petitioner "recently 
submitted a paper for publication to in which he 
"reported a unique way to treat prosthetic valve malfunction in preparation for pump deactivation in 
a patient with LV AD" (left ventricular assist device). As the research discussed in and 
letters was published or presented long after the petition was filed, 
it does not establish 
the Petitioner's eligibility at the time of filing. 
Other medical faculty discussed the Petitioner's cardiovascular disease research. With respect to the 
Petitioner's study concerning 
professor of internal medicine at indicated the Petitioner found 
that, "contrary to commonly accepted assumptions," "does not occur in females during the 
last month of gestation or first few months of delivery, but that it affects a wider range of patients." 
contended that the Petitioner's work provides his "his peers with a greater 
understanding of the condition." Furthermore, associate professor of medicine 
at stated that the Petitioner performed a study in which "he reviewed over three years of 
outcomes" of percutaneous coronary intervention (PCI) and concluded that "patients who had more 
complex and lengthy procedures experience more bleeding."9 indicated that the 
Petitioner's "promising results require further study" and have "potential" to lead to advances in 
acute coronary syndrome treatment. 
While we recognize that research must add information to the pool of knowledge in some way in 
order to be accepted for publication, funding, or academic credit, not every individual who has 
performed original research will be found to be well positioned to advance his or her proposed 
research. Rather, we examine the factors set forth in Dhanasar to determine whether, for instance, 
the individual's progress towards achieving the goals of the proposed research, record of success in 
similar efforts, or generation of interest among relevant parties supports such a finding. !d. at 890. 
In this case, the record demonstrates that the Petitioner has conducted and published research during 
his medical training. He has not shown, however, that his research has been frequently cited by 
independent cardiologists or otherwise served as an impetus for progress in the field, that it has 
affected clinical practice, or that it has generated substantial positive discourse in the broader 
medical community. Nor does the record demonstrate another factor that renders the Petitioner well 
positioned to advance his proposed endeavor. Accordingly, he has not established that he satisfies 
the second prong of the Dhanasar framework. 
C. Balancing Factors to Determine Waiver's Benefit to the United States 
The Petitioner asserts that it would be impractical for him "to secure a job offer or obtain a labor 
certification." He states that "[b]ecause he is engaged in a training program that does not amount to an 
offer of permanent employment, he is not elig~ble for labor certification." Additionally, he contends 
9 
PCI is a live saving measure for patients with acute coronary syndrome "involving the placement of a stent in the 
acutely occluded artery." 
Matter of A-R-A-A-E-
· that he has performed "valuable research" as part of his fellowship and that "he intends to continue this 
important rese<;rrch that he could not otherwise complete in another position." 
I 
While we acknowledge that the Petitioner's participation in an interventional cardiology training 
program makes obtaining a labor certification impracti~al at this stage of his career, he has not 
demonstrated, as claimed, that he presents benefits to the United States through his proposed endeavor 
that outweigh those inherent in the labor certification process. With respect to his cardiology 
research, the Petitioner has not shown an urgent national interest in his own efforts, nor has he 
demonstrated that he offers contributions of such value that, over all, they would benefit the nation even 
if other qualified U.S. workers were available. In sum, the Petitioner has not demonstrated that, on 
balance, it would be beneficial to the United States to waive the requirements of a job offer and thus 
of a labor certification. The Petitioner therefore has not established that he meets the third prong of 
the Dhanasar framework. 
III. CONCLUSION 
As the Petitioner has not met the requisite three prongs set forth in the Dhanasar analytical framework, 
we find that he has not established eligibility for or otherwise merits a national interest waiver as a 
matter of discretion. 
ORDER: The appeal is dismissed. 
Cite as Matter of A-R-A-A-E-, ID# 279893 (AAO May 10, 2017)