Scott Vermillion, former American soccer player, had CTE

Scott Vermillion’s family members are still struggling to articulate the tangle of emotions they felt when they received the call from doctors last November.

Vermillion, a former MLS player, had died almost a year earlier, on Christmas Day 2020, at the age of 44. The direct cause was acute alcohol and prescription drug intoxication, his family said, a dour coda to a troubled life: A high school and college All-American who played four seasons in MLS, Vermillion had spent the last decade of his life doing so to withdraw from his family as he struggled with substance abuse and increasingly erratic behavior.

Late last year, Boston University doctors offered a different explanation: After examining Vermillion’s brain, his family’s BU experts said he suffered from chronic traumatic encephalopathy, or CTE, a degenerative brain disorder associated with symptoms including memory loss, depression, and associated with aggressive or impulsive behavior.

The diagnosis gave Vermillion the distinction of being the first American professional footballer with a public case of CTE. It was also a celebratory milestone for MLS, a league that, even in its young history, has seen the aftermath of this type of CTE brain injury more commonly associated with collision sports like soccer, boxing and hockey.

“Football is definitely a risk for CTE – not as much as soccer, but definitely a risk,” said Dr. Ann McKee, director of the CTE Center at Boston University.

McKee, a neuropathologist, has found the disease in hundreds of athletes, including Vermillion.

For Vermillion’s family, the diagnosis brought a modicum of clarity to a life full of questions. It didn’t answer everything – it just couldn’t, as CTE can only be diagnosed posthumously. It triggered feelings of doubt, guilt, anger, relief. But it was finally something.

The specter of CTE began hovering over the NFL nearly two decades ago when the first cases of the disease were found in the brains of former professional football players. Since then, CTE, which is associated with repeated blows to the head, has been detected in the brains of more than 300 former NFL players.

In football, however, research and public debate about CTE and head injuries is still emerging, even as confirmed cases are increasing. An English striker. A Brazilian world champion. An American amateur.

Former MLS players Alecko Eskandarian and Taylor Twellman have been vocal about how concussions ended their careers and impacted their personal lives. Brandi Chastain, two-time women’s world champion, publicly pledged in 2016 to donate her brain to CTE research.

“We need to understand the gravity of the situation,” Chastain said. “Talking about concussions in football isn’t just a hot topic. It’s a real thing. It needs real attention.”

In the past year, leagues and tournaments around the world, including MLS, began experimenting with so-called concussion substitutes, which grant teams extra substitutions to deal with players with potential brain injuries. MLS has joined some other sports leagues to implement a variety of other protocols, including using independent specialists and observers to assess possible concussions during games.

“MLS has a comprehensive policy in place to educate players, coaches, officials and medical personnel on the importance of head injury detection, early detection and treatment,” said Dr. Margot Putukian, the league’s chief medical officer, in a statement. “There is always more progress to be made and MLS is unwaveringly committed to this important work.”

However, the focus is not just on treating concussions. In a growing effort to prevent headbutts of all types, players of all levels are seeing more policies aimed at limiting headers.

A 2019 study by researchers in Glasgow showed that former professional footballers were three and a half times more likely to die from neurodegenerative diseases than members of the general population (and less likely to die from heart disease and some cancers). The story of Vermillion is thus the latest in a string of recent alerts.

“CTE had never crossed our minds,” said Cami Jones, who was married to Vermillion from 1999 to 2004.

Vermillion started playing soccer in Olathe, Kan. when he was 5 years old. He loved the game’s non-stop motion, swashbuckling action, family members said. His coaches in elementary school often let him sit on the bench for a long time because he would score too many goals, his father David Vermillion said.

His talent eventually earned him spots on elite regional club teams and US youth national teams as a teenager. It took him to the University of Virginia, where he was an all-American third-team player in his junior year. It led him to MLS, where he joined his local club, the Kansas City Wizards, now known as Sporting Kansas City, in 1998 at the age of 21.

But Vermillion, a rowdy defense attorney, never fully blossomed as a pro. He moved to two other clubs before being forced to retire early after the 2001 season with a nagging ankle injury. His career earnings in the young league were meager; His father recalled that his son’s salary was about $40,000 a year when he left the game.

“It was a big blow,” said David Vermillion. “He’s spent his whole life trying to get up that hill, climb that hill, make himself a good player and it was hard to end that abruptly.”

Scott Vermillion was trying to find a foothold in his life after football. He ran a family shop. He coached local youth teams. He aspired to study nursing. But his relations slowly dissolved.

Though Vermillion’s behavior became most concerning in the decade before his death, Jones said she noticed changes in him even before his career was over: he was often lethargic, which struck her as odd for a professional athlete, and frequently complained of headaches.

“When I met Scott, he was a lively, outgoing professional athlete, super funny, a joker,” said Jones, who divorced Vermillion in 2004, three years after retiring when their children were 1 and 3 years old. “I watched him change very quickly and it was scary.”

Over the next decade, Vermillion continued to withdraw from his family. His drinking became extreme and his behavior more erratic, family members said. He married a second time, but this union only lasted about a year. In 2018 he was arrested and charged with serious domestic violence following an incident with a friend. He entered and dropped out of alcohol and prescription drug rehab programs, showing up only to point out to his family that the programs weren’t helping him, that he couldn’t be helped.

His daughter Ava-Grace had gotten used to him missing her dance nights. His son Braeden, now 22, was devastated when he missed his high school graduation.

“He would promise a lot of things and basically just make excuses and not show up for us,” said Ava-Grace Vermillion, 20.

dr Stephanie Alessi-LaRosa, an exercise neurologist in Hartford, Connecticut, cautioned against making causal links between posthumous CTE diagnoses and behavioral patterns in a person’s life. She said research on the subject is still in its early stages and doctors are still trying to understand why some athletes got CTE and others didn’t.

“I have patients who are reluctant to seek psychiatric treatment because they think they have CTE and are doomed,” she said. “I think it’s important that patients get the help they need and if their family is concerned, take them to a sports neurologist.”

Alessi-LaRossa said she thinks the benefits of the sport outweigh the risks, but reiterated the increasingly popular idea that the sport in football should be restricted for young players.

In 2015, US Soccer announced – to settle a dispute – a ban on headers in games and practices for players under the age of 10 and issued guidelines restricting headers in practice for older players. And last year English football officials published guidelines for heading, recommending that professional players limit so-called ‘higher-power headers’ to 10 per week in training. (Exactly how this was to be enforced was less clear.)

Vermillion’s mother, Phyllis Lamers, contacted the Boston lab to have her son’s brain examined after his death. CTE has four stages, the last stage is associated with dementia; Scott Vermillion was diagnosed with stage 2 CTE

His family said they hoped that publishing his story, painful as it may be to relive it, could help educate families about the hidden risks of football. They said they regretted how harsh they were on him, how they sometimes interrupted him when his behavior was too difficult to manage. They agonized and wondered if they could have done more.

Ava-Grace Vermillion recalled texting her father on December 23, 2020, his 44th birthday. She hadn’t seen him in almost a year, she said, and as she prepared to go to college in California to study dance, she felt compelled to break the ice.

“I remember the day so clearly,” she said. “I was at work and thought it was time to contact him. I hadn’t spoken to him for a while. I texted him saying, ‘I hope you’re okay.’ He called me back and I couldn’t answer. And he died two days later.”

Ken Belson contributed reporting.