dismissed EB-2 NIW Case: Healthcare Management

U.S. Citizenship 
and Immigration 
Services 
Non-Precedent Decision of the
Administrative Appeals Office 
Date: DEC. 6, 2023 In Re: 29023686 
Appeal of Nebraska Service Center Decision 
Form 1-140, Immigrant Petition for Alien Workers (National Interest Waiver) 
The Petitioner, a hospice, seeks second preference immigrant classification for the Beneficiary, a 
healthcare management specialist, as a member of the professions holding an advanced degree or as 
an individual of exceptional ability, as well as a national interest waiver of the job offer requirement 
attached to this EB-2 classification. 1 Immigration and Nationality Act (the Act) section 203(b )(2), 
8 U.S.C. § 1153(b )(2). 
The Director of the Nebraska Service Center denied the petition and dismissed a subsequent motion, 
concluding the Petitioner had not established the Beneficiary's eligibility for a waiver of the required 
job offer, and thus of the labor certification, would be in the national interest. The matter is now before 
us on appeal. 8 C.F.R. § 103.3. 
The Petitioner bears the burden of proof to demonstrate eligibility by a preponderance of the evidence. 
Matter ofChawathe, 25 l&N Dec. 369, 375-76 (AAO 2010). We review the questions in this matter 
de novo. Matter of Christo 's, Inc., 26 l&N Dec. 537, 537 n.2 (AAO 2015). Upon de novo review, 
we will dismiss the appeal. 
I. LAW 
To establish eligibility for a national interest waiver, petitioners must 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. Section 203(b )(2)(B)(i) of the Act. In addition, 
petitioners must show the merit of a discretionary waiver of the job offer requirement "in the national 
interest." Section 203(b )(2)(B)(i) of the Act. Matter ofDhanasar, 26 I&N Dec. 884, 889 (AAO 2016) 
provides that U.S. Citizenship and Immigration Services (USCIS) may, as matter of discretion2, grant 
a national interest waiver if: 
1 As indicated in the brief, the Beneficiary 's spouse purchased the Petitioner in 2017. After the Beneficiary 's spouse 
divested from the Petitioner, the Beneficiary's mother-in-law currently owns and operates the Petitioner. 
2 See also Poursina v. USCIS, 936 F.3d 868 (9th Cir. 2019) (finding USCIS' decision to grant or deny a national interest 
waiver to be discretionary in nature). 
• The proposed endeavor has both substantial merit and national importance, 
• The individual is well-positioned to advance their proposed endeavor, and 
• On balance, waiving the job offer requirement would benefit the United States. 
II. ANALYSIS 
Regarding the national interest waiver, the first prong relates to substantial merit and national 
importance of the specific proposed endeavor. Dhanasar, 26 I&N Dec. at 889. At initial filing, the 
Petitioner's cover letter stated: 
... [E]ven the best hospice care providers sometimes cannot determine the actual cause 
of death, because many of the hospice recipients have more the particular medical 
condition because of which the certifying physician referred the patient to hospice. A 
significant minority of patients (12%-15%) survive 6 months or more. Little is known 
about this population and how these patients differ from those with a more abrupt 
decline. Nor is it known whether hospices might be able to accurately predict which 
patients are likely to survive longer than 6 months. If hospice provider is able to detect 
how such additional conditions affect the patients it would enhance quality of life and 
alleviate suffering of hospice recipients. Also, the existing hospice providers, 
especially small ones do not have effective management of their resource and staff 
. . . . This endeavor has both significant merit and national importance because a 
specific management system of staff and procedures can be used by different providers 
and will allow the petitioner increase scope and quality of their services thus alleviating 
suffering of many and to a good percentile with prolonged life. 
In response to the Director's request for evidence, the Petitioner offered a statement from the 
Beneficiary indicating: 
In my work on the basis of the Hospice, I set the task of studying the main groups of 
psychosomatic diseases of patients with the subsequent development of a methodology 
for their psychological correction aimed at reducing the development and progression 
of the disease, as well as the development of detailed guidelines for each group of 
workers in contact with the patient, for each group psychosomatic illness. The value 
of the results of this study will be the possibility of using and implementing 
methodological developments not only in hospices, but also in any other medical 
institutions, where, as a result of identifying psychosomatic diseases at an early stage, 
the most effective prevention of the development of the disease will be possible, up to 
a complete recovery, and, as a result, a decrease in economic costs in the healthcare 
sector, because psychosomatic diseases require systematic diagnostic procedures, 
supervision of medical specialists, and medication. 
My main goal is to utilize the results of my research to propose a national program 
which can increase longevity and quality of life for hospice patients. By doing so, we 
are hopeful to encourage individuals to live, rather than succumbing to a poor 
prognosis. The development and adherence of such programs can go beyond hospice 
care and into hospitals, skilled nursing facilities, and community programs. A holistic, 
2 
rather than biomechanical, approach to healthcare has been proven to decrease 
individual and governmental financial costs in global studies. I am confident that such 
a program will not only be beneficial medical[ly ], but financially as well on a national 
level. 
Another problem identified on the basis of the work of the hospice is that the work of 
the hospice staff is traveling in nature - often hospice patients live in different parts of 
the city. The problem of individual planning of the work schedule and the time 
limitation of medical personnel leads to a limitation of the employee's time spent with 
the patient, and, as a result, insufficient attention period. To avoid the above problems, 
I have developed a program designed to plan and optimize the work of hospice staff. 
The Director found the Petitioner demonstrated the proposed endeavor's substantial merit but not its 
national importance. On motion, the Petitioner argued: 
The [B]eneficiary's endeavor, which she began at [P]etitioner's facility, is to advance 
her research on psychosomatic triggers in hospice settings, and to farther develop 
practical instructions to the staff of palliative care organizations on how to deal with 
these triggers to help hospice patients to cope and improve the conditions associated 
with these triggers. 
On appeal, the Petitioner maintains the national importance of the Beneficiary's proposed endeavor. 
In determining national importance, the relevant question is not the importance of the industry or 
profession in which the individual will work; instead, we focus on "the specific endeavor that the 
foreign national proposes to undertake." See Dhanasar, 26 I&N Dec. at 889. Although the Petitioner 
submitted evidence regarding hospice facts and figures, the Petitioner must demonstrate the national 
importance of the Beneficiary's specific, proposed endeavor rather than the importance of hospice and 
related care. 3 In Dhanasar, we noted that "we look for broader implications" of the proposed endeavor 
and that "[ a ]n undertaking may have national importance for example, because it has national or even 
global implications within a particular field." Id. We also stated that "[a]n endeavor that has 
significant potential to employ U.S. workers or has other substantial positive economic effects, 
particularly in an economically depressed area, for instance, may well be understood to have national 
importance." Id. at 890. We note the Petitioner also provide evidence regarding hospice staffing 
shortages. However, occupational shortages do not render a proposed endeavor nationally important 
under the Dhanasar framework. In fact, such shortages of qualified workers are directly addressed by 
the U.S. Department of Labor through the labor certification process. 
Furthermore, to evaluate whether the proposed endeavor satisfies the national importance requirement, 
we look to evidence documenting the "potential prospective impact" of the work. Dhanasar, 26 I&N 
Dec. at 889. Although the Beneficiary's statement briefly discusses her "research to propose a national 
program," the Petitioner did not show how the Beneficiary intended to disseminate her research 
findings and proposed program, such as through presentation or publication throughout her field, to 
show a broader impact. The record contains no evidence of the Beneficiary's plans for publication, 
3 The Petitioner's arguments and evidence relate to the substantial merit aspect of the proposed endeavor rather than the 
national importance part. 
3 
presentation, or distribution of her work in the field, nor is there evidence reflecting the intention of 
her broadly sharing her future work in the healthcare industry. 4 Rather, the Petitioner offered letters 
from select individuals indicating that they are experimenting with or applying the Beneficiary's 
concepts in their own facilities. 5 As such, the Petitioner did not establish how the Beneficiary's 
proposed endeavor would largely influence the field and rise to the level of national importance. In 
Dhanasar, we determined the petitioner's teaching activities did not rise to the level of having national 
importance because they would not impact his field more broadly. Id. at 893. Likewise, the record 
does not show through supporting documentation how the Beneficiary's program concepts stand to 
sufficiently extend beyond the limited patients of selected doctors who were introduced to the 
Beneficiary's research, to impact the industry or the U.S. economy more broadly at a level 
commensurate with national importance. 
Further, the Petitioner also contends that it presented an expert opinion letter from Dr. H-A-N-, who 
found the proposed endeavor has national importance. However, the letter also does not indicate how 
the Beneficiary's work will be distributed or disseminated throughout the field, to establish the broader 
impact of the Beneficiary's work. Moreover, the letter does not explain how the Beneficiary's research 
would have a wider influence in the field. Instead, the letter makes vague, general statements about 
hospice, palliative care, and treatment relating to national or global implications, significant potential 
to employ U.S. workers or other substantial positive economic effects, and enhancing societal welfare 
without specifically explaining how the Beneficiary's particular endeavor would impact any of these 
areas. For instance, the letter claims that the Beneficiary's "proposed endeavor in the field of hospice 
and palliative care is directly related [to] a number of government programs and initiatives, which 
farther speaks to the importance of her presence and work in the United States." While the letter 
proceeds to list Medicare, the U.S. Department of Health and Human Services, the Centers for 
Medicare and Medicaid Services, the National Institutes of Health, and proposed bills, the letter does 
not articulate how the Beneficiary's specific work would affect any of these governmental agencies, 
programs, or initiatives. Without specific, detailed information, the letter does not establish the 
national importance of the Beneficiary's proposed endeavor. 
Finally, for the reasons discussed about Dr. H-A-N-'s letter, the Petitioner also did not show that the 
Beneficiary's proposed endeavor has significant potential to employ U.S. workers or otherwise offers 
substantial positive economic effects for our nation. Without credible evidence regarding any 
projected U.S. economic impact or job creation attributable to the Beneficiary's future work, the record 
does not demonstrate any benefits to the U.S. regional or national economy resulting from the 
Beneficiary's research or program would reach the level of "substantial positive economic effects" 
contemplated by Dhanasar, 26 I&N Dec. at 890. 
Because the documentation in the record does not establish the national importance of the proposed 
endeavor as required by the first prong of the Dhanasar precedent decision, the Petitioner has not 
demonstrated the Beneficiary's eligibility for a national interest waiver. Further analysis of her 
4 Although more applicable under the second prong of the Dhanasar framework, the record contains no evidence of the 
Beneficiary's experience of publishing, presenting, or distributing her research or work. The Beneficiary's resume does 
not list any scholarly article publications, conference presentations, or other professional distributions. 
5 None of the letters indicate how they became aware of the Petitioner's research, techniques, or proposed program. 
4 
qualification under the second and third prongs outlined in Dhanasar, therefore, would serve no 
meaningful purpose. 6 
III. CONCLUSION 
As the Petitioner has not met the 
requisite first prong ofthe Dhanasar analytical framework, we conclude 
that it has not demonstrated the Beneficiary's eligibility for or otherwise merits a national interest 
waiver as a matter of discretion. The appeal will be dismissed for the above stated reasons, with each 
considered as an independent and alternate basis for the decision. 
ORDER: The appeal is dismissed. 
6 See INS v. Bagamasbad, 429 U.S. 24, 25 (1976) (stating that agencies are not required to make "purely advisory findings" 
on issues that are unnecessary to the ultimate decision); see also Matter ofL-A-C-, 26 l&N Dec. 516,526 n.7 (BIA 2015) 
( declining to reach alternate issues on appeal where applicants do not otherwise meet their burden of proof). 
5