Scott Vermillion’s family members still struggle to articulate the jumble of emotions they felt last November when they received the phone call from the doctors.
Vermillion, a former M.L.S. player, had died almost a year earlier, on Christmas Day in 2020, at age 44. The direct cause was acute alcohol and prescription drug poisoning, his family said, a dour coda to a troubled life: A high school and college all-American who played four seasons in M.L.S., Vermillion had spent the last decade of his life withdrawing from his family as he struggled with substance abuse and progressively erratic behavior.
Late last year, doctors at Boston University offered another explanation: After examining Vermillion’s brain, the B.U. experts told his family that he had chronic traumatic encephalopathy, or C.T.E., a degenerative brain disease linked to symptoms like memory loss, depression and aggressive or impulsive behavior.
The diagnosis gave Vermillion the grave distinction of being the first American professional soccer player with a public case of C.T.E. It was a solemn milestone, too, for M.L.S., a league that has, even in its young history, seen the consequences of the type of brain injuries more commonly associated with collision sports like football, boxing and hockey.
“Soccer is clearly a risk for C.T.E. — not as much as football, but clearly a risk,” said Dr. Ann McKee, the director of the C.T.E. Center at Boston University.
A neuropathologist, McKee has found the disease in hundreds of athletes, including Vermillion.
For Vermillion’s family, the diagnosis brought a sense of clarity, however small, to a life littered with questions. It did not answer everything — it simply could not, given that C.T.E. can be diagnosed only posthumously. It triggered feelings of doubt, guilt, anger, relief. But it was, at long last, something.
The specter of C.T.E. began hovering over the N.F.L. almost two decades ago, when the first cases of the disease were found in the brains of former professional football players. Since then, C.T.E., which is associated with repeated blows to the head, has been discovered in the brains of more than 300 former N.F.L. players.
In soccer, though, the research and public conversation around C.T.E. and head injuries are still emerging, even as the confirmed cases mount. An English striker. A Brazilian World Cup winner. An American amateur.
The former M.L.S. players Alecko Eskandarian and Taylor Twellman have been vocal about how concussions ended their careers and affected their personal lives. Brandi Chastain, a two-time Women’s World Cup winner, publicly pledged in 2016 to donate her brain for C.T.E. research.
“We have to understand the gravity of the situation,” Chastain said. “Talking about concussions in soccer is not just a hot-button topic. It’s a real thing. It needs real attention.”
Last year, leagues and tournaments around the world, including M.L.S., began experimenting with so-called concussion substitutes, which grant teams additional substitutions to deal with players with potential brain injuries. M.L.S. has joined some other sports leagues in implementing a variety of other protocols, including the use of independent specialists and spotters to assess potential concussions during games.
“M.L.S. has comprehensive policies to educate players, coaches, officials and medical staffs about the importance of head injury identification, early reporting, and treatment,” Dr. Margot Putukian, the league’s chief medical officer, said in a statement. “There is always more progress to be made, and M.L.S. is staunchly committed to this important work.”
The focus, though, is not only on treating concussions. In a growing effort to prevent head impacts of all kinds, players at every level are seeing more guidelines aimed at limiting headers.
Head Injuries and C.T.E. in Sports
The permanent damage caused by brain injuries to athletes can have devastating effects.
A study in 2019 by researchers in Glasgow showed former professional soccer players were three and a half times more likely than members of the general population to die from neurodegenerative disease (and less likely to die of heart disease and some cancers). Vermillion’s story, then, becomes the latest in a recent string of cautionary tales.
“C.T.E. had never even 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 incessant movement of the game, the swashbuckling action, family members said. His coaches in elementary school, in the interest of sportsmanship, often kept him on the bench for long stretches because he would score too many goals, said his father, David Vermillion.
His talent eventually earned him places on elite regional club teams and U.S. youth national teams as a teenager. It took him to the University of Virginia, where he was a third-team all-American in his junior year. It carried him to M.L.S., where he joined his local club, the Kansas City Wizards, now known as Sporting Kansas City, in 1998 at age 21.
But Vermillion, a scrappy defender, never fully blossomed as a pro. He moved on to two other clubs before a nagging ankle injury forced his early retirement after the 2001 season. His career earnings in the fledgling league were meager; his father recalled his son’s salary being around $40,000 a year when he left the game.
“It was a big blow,” David Vermillion said. “He spent all of his life climbing that hill, moving up, making himself a good player, and to abruptly have it end was tough.”
Scott Vermillion tried to find some footing in his life after soccer. He managed a family store. He coached local youth teams. He pursued a nursing degree. But his relationships were slowly unraveling.
Though Vermillion’s behavior would grow 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 vibrant, outgoing pro athlete, super fun, a jokester,” said Jones, who divorced Vermillion in 2004, three years after his career ended, when their children were 1 and 3. “I watched him change really rapidly, 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 that union lasted only about a year. In 2018, he was arrested, accused of aggravated domestic battery after an incident with a girlfriend. He went in and out of rehabilitation programs for alcohol and prescription drugs, emerging only to insist to his family that the programs did not help him, that he was incapable of being helped.
His daughter, Ava-Grace, got accustomed to him missing her dance recitals. 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, a sports neurologist in Hartford, Conn., cautioned against drawing causal links between posthumous C.T.E. diagnoses and patterns of behavior in a person’s lifetime. She said research on the subject was still in its early stages, and that doctors were still trying to understand why some athletes got C.T.E. while others did not.
“I have patients who are hesitant to get psychiatric treatment because they think they have C.T.E. and are doomed,” she said. “I think it’s important for patients to get the help they need, and if their family is concerned, get them to a sports neurologist.”
Alessi-LaRossa said she thought the benefits of sports outweighed the risks, but echoed the increasingly widespread idea that heading in soccer should be restricted for youth players.
In 2015, U.S. Soccer — resolving a lawsuit — announced a ban on heading in games and practices by players under 10 and created guidelines for restricting heading in practice for older players. And last year, English soccer officials released guidelines for heading, recommending professional players limit so-called “higher force headers” to 10 per week in training. (How, exactly, this should be enforced has been less clear.)
Vermillion’s mother, Phyllis Lamers, contacted the Boston laboratory about having her son’s brain examined after his death. C.T.E. has four stages, the final stage associated with dementia; Scott Vermillion was found to have Stage 2 C.T.E.
His family said they hoped coming forward with his story, however painful it might be to relive, could help inform families about the hidden risks of soccer. They said they regretted how hard they were on him, how they cut him off at times when his behavior became too difficult to handle. They agonized wondering if they could have done more.
Ava-Grace Vermillion recalled texting her father on Dec. 23, 2020, his 44th birthday. She had not seen him in close to a year, she said, and as she prepared to head off to college in California to study dance, she said she felt compelled to break the ice.
“I remember the day so specifically,” she said. “I was at work and just thought it was time I reach out to him. I hadn’t talked to him in a while. I sent him a text saying, ‘Hope you’re doing well.’ He called me back, and I didn’t get to answer. And he died two days later.”
Ken Belson contributed reporting.