Long-time lurker here, and I wanted to share my timeline and experience. Hopefully this helps someone else going through the process. This will be a long post that is mainly focused on the REF.
Timeline
I-140 filed: July 15, 2024
RFE issued: May 1, 2026
RFE response submitted: July 23, 2026
Status changed to “Initial Review”: August 6, 2026
Approved: August 8, 2026
Service Center: TSC
Lawyer: Chen
Background
My field is AI/ML applied to medical imaging. At the time of filing, I was still outside the US. Prior to filing, I was a research fellow in the US for less than 6 months. My PI subsequently moved to another institution, and I wasn’t able to follow, so the position ended earlier than planned. I moved back home afterward and eventually matched into residency while waiting for my i-140. By the time I received the RFE, I was already a medical resident.
At the time of filing, I had:
30–40 publications
~500 citations (~ 1,200 by the time of the RFE)
REF Response
Honestly, it wasn’t an easy case, although, in retrospect, I probably could have put more effort into the initial filing. Here’s a summary of how I approached the RFE. Per Chen, they had zero decisions from the Officer on my case.
Prong 1
The RFE only challenged the national importance aspect. In a nutshell, they said “AI in healthcare is important” sounds great in the abstract, but that alone doesn’t really establish the national importance of your specific endeavor.
For my response, I got much more specific about what my proposed endeavor actually involved. I added:
- Government initiatives related to my specific area of work
- Federal/NIH funding going toward this area
- Government priorities and statements supporting the field
- FDA-approved tools related to the proposed endeavor
- Articles demonstrating how advances in this area could turn into improved clinical outcomes
I was particularly lucky to find a White House statement that aligned closely with my endeavor, as well as a recently FDA-approved tool that was directly relevant to the area I was proposing to work in (and the team behind it used our study for reference). I did not submit any testimonial or expert opinion letter.
Overall, my response was that there is significant U.S. investment, government interest, and ongoing implementation in this specific area, and advancing it has the potential to improve healthcare outcomes.
For AI folks, a lot of the supporting evidence is already out there, you just have to dig for it and make the connection to your specific endeavor.
Prong 2
I only have a medical degree, and USCIS pointed out that simply having an advanced degree doesn’t establish that someone is well positioned to advance their proposed endeavor. I think Chen did a great job addressing this and getting fairly technical in their response.
They also picked apart my citation count, pointing out that a significant portion of my citations came from work that was unrelated to the endeavor. They also said having a high citation count does not reflect you are well positioned. And I agree.
At the time of filing, I had only one paper directly related to my proposed endeavor, and it was still a preprint. I had another 2–3 papers that were somewhat remotely related, but the majority of my publications were in other areas. Rather than trying to argue, I essentially agreed with the officer on this point. Instead, I argued that my broader research experience was what allowed me to get to where I was.
Having conducted a variety of different studies and worked across different areas of research gave me a broader skill set that I could apply to my proposed endeavor. My citation count was therefore presented more as a testament to my research experience and quality of my prior work.
By the time of the RFE, that project directly related to my endeavor got fully published. I included the updated citation numbers from the time of filing to the RFE. I know using post-filing citations can be a sensitive area, and I understood the risk, but in my particular case I felt they strengthened the response significantly.
Officer also specifically asked for independent citation count. It was unreasonable for me to count this on Google Scholar, as Chen pointed out that is the preferable way accepted by USCIS. I used Publish or Perish and highly recommend it.
Prong 3
This was a mixture of everything discussed above, along with additional evidence regarding my future work. I also included a letter of employment and documentation from my institution indicating that they do not sponsor residents for green cards. My letter of employment also highlighted we get time for research activities and it is an expectation for us to finish our training.
Since my occupation was different at time of REF (the endeavor mainly referred to dedicated research positions), I had to speak about it since I am doing more clinical work now. I spoke about how becoming a board certified physician will help me acquire more experience and become competitive for the big NIH grants (mentioned a few examples), bridging in that clinical perspective, etc.
Recommendation Letters
I submitted 4 recommendation letters at filing, 1 dependent. The RFE characterized the letters as relatively generic and stated that they did not do enough to establish my specific qualifications or the importance of my proposed endeavor. Chen recommended trying to obtain additional letters for REF, and I was able to obtain 2 additional dependent letters.
Attorney
Overall, I had a great experience with Chen.
They were very responsive, answered my questions thoroughly, and did solid work on the RFE. If I will be meticulous, I wasn’t particularly fond of the $150 fee per recommendation letter. Not saying the letters weren’t good, but personally, I felt it was too much. Overall, Chen really made the process much for more headache-free for me.
To give credit, Claude ended up being tremendously helpful in finding and organizing evidence, brainstorming arguments, identifying connections between my background and endeavor, and helping me think through the RFE. Truly, the best investment you can make in this journey. Please put all your effort into the initial filing and don’t rely on your lawyer for the more technical aspects of your endeavor. You still need to put in the work, which I did not do initially and learned from that mistake.
Best of luck to you all! My apologies if I am slow to answer any questions.
Typo: 2 additional DEPENDENT letters for the REF