Researchers with Boston University’s chronic traumatic encephalopathy (CTE) center have diagnosed a Major League Soccer (MLS) player with the disease for the first time.

Former Sporting Kansas City defender Scott Vermillion suffered from the degenerative brain disease, the researchers said on Tuesday. Vermillion, 44, died of an accidental drug overdose on Christmas Day in 2020.

Vermillion’s official cause of death was listed as acute alcohol and prescription drug poisoning after he “spent the last decade of his life withdrawing from his family as he struggled with substance abuse and progressively erratic behavior,” his family told The New York Times. Vermillion also suffered from memory loss.

All his symptoms have been linked to CTE, which is believed to be caused by repeated head trauma. It is not possible to directly connect any cause to CTE. However, it is usually found in participants of high-collision sports, like football, boxing, mixed martial arts, and hockey.

CTE has been diagnosed in more than 100 former NFL players and semi-pro and high school soccer players. Vermillion is the first to be diagnosed from MLS.

Vermillion played on the United States under-17 team in 1992 and 1993 and the under-20 team in 1996. He played four seasons in the MLS from 1998 to 2001 with Kansas City, the Colorado Rapids, and D.C. United.

“This disease destroys families, and not just football families,” said Vermillion’s father, Dave Vermillion. “We hope this will be a wake-up call to the soccer community to support former players and get them the help they need, so some good can come from this tragedy.”

The MLS Players Association called on the league to break from the sport’s international governing bodies and expand the limits on substitutions to allow players with concussions to be taken out.

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“We must not sit by and wait for them to do the right thing. MLS should unilaterally adopt a full concussion substitution rule immediately,” the union said in a statement. “Current substitution rules do not give medical professionals sufficient time to properly diagnose potential concussions without putting a team at a substantial competitive disadvantage.”

A 2017 study conducted by Acta Neuropathologica found that soccer players who frequently use their heads to pass and shoot the ball are at high risk of suffering long-term brain damage.

The study examined the brains of six deceased male soccer players with extended playing careers who had been diagnosed with dementia. Four of the six brains showed evidence of CTE.

Dr. Ann McKee, the director of the Boston University’s CTE Center, told the New York Times that soccer is “clearly a risk” for CTE.

Additionally, a 2019 study by researchers at the University of Glasgow found that professional soccer players were around 3.5 times more likely than the general population to die from a neurodegenerative disease.

MLS Chief Medical Officer Margot Putukian said the league has “comprehensive policies to educate players, coaches, officials and medical staffs about the importance of head injury identification, early reporting, and treatment.”

“MLS is a leader in the sport, advocating for and piloting the FIFA concussion substitute program, implementing a medical spotter program to identify potential head injuries, and removing from play any player with a suspected head injury for assessment and, as necessary, treatment,” Putukian said. “There is always more progress to be made, and MLS is staunchly committed to this important work.”

Taylor Twellman, who played soccer for the U.S. Men’s National Team from 2002 to 2008, told MedLinePlus.gov that he suffered “six or seven diagnosed concussions” throughout his career.

“All of the concussions except one knocked me unconscious,” Twellman added while noting the final concussion he suffered in 2008 ended his career.

Former U.S. Women’s National Team player Brandi Chastain announced in 2016 that she would donate her brain to the Concussion Legacy Foundation (CLF) after her death.

“I’m part of asking, ‘Why are we more susceptible to this?'” said Chastain. “If I could help get to the bottom of this, that’s great.”

The CLF has called for rules prohibiting children under 14 from playing tackle football and heading the ball in soccer. CLF co-founder Chris Nowinski said dementia had been linked to repetitive heading by pro soccer players in Britain.

“It is time for the global soccer community to have a real conversation about heading, especially in the youth game,” Nowinski said. “We urgently need to investigate how far this crisis extends into amateur soccer and immediately put in place reforms to prevent CTE in the next generation.”

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