Former NFL Players: Disabilities, Benefits, and Related Issues

Former NFL Players: Disabilities, Benefits, and Related Issues

Order Code RL34439
Former NFL Players: Disabilities, Benefits, and
Related Issues
April 8, 2008
L. Elaine Halchin
Analyst in American National Government
Government and Finance Division

Former NFL Players: Disabilities, Benefits, and Related
Issues
Summary
Professional football is a very popular sport, and the physical nature of the
game of football is part of its appeal, but, at the same time, playing the game can
exact a physical and mental toll on players. Violent collisions, as well as other
aspects of the sport, can and do cause injuries. Each week during the season, the
National Football League (NFL) releases an injury report that lists, for each team,
players who are injured, the type or location of the injury (for example, “concussion,”
“knee,” or “ribs”), and the players’ status for the upcoming game. During the 2007
season, aside from weeks one and eight, at least 10% of NFL players were identified
each week as being injured. Players’ injuries and current health conditions (for
example, excess weight and sleep apnea) might have long-term consequences for
their health, meaning that today’s injury might become a chronic health problem or
disability during retirement from the NFL. The issue has received considerable
attention from Congress, including hearings in both chambers.
Through collective bargaining agreement (CBA) negotiations and other
discussions, the NFL and the NFL Players Association (NFLPA) have established a
number of benefits, including retirement benefits (that is, a pension), severance pay,
total and permanent disability benefits, and an annuity program. Some benefits are
available to all players, while other benefits are available only to players who played
in the NFL during certain years. Additionally, some benefits have eligibility
requirements. Funds for benefits that are included in the CBA come from the portion
of the league’s total revenues that is allocated to the players. Apparently, the NFL
and the NFLPA determine how to fund other benefits.
The NFL and the NFLPA have taken steps to promote the health and safety of
players. The league has established several committees, such as the Mild Traumatic
Brain Injury (MTBI) Committee, and, through NFL Charities, awards grants for
medical and scientific research related to health and safety issues. The NFLPA has
a medical advisor and a performance consultant, and there is an NFL-NFLPA joint
committee on player safety.
The subject of injuries, disabilities, and benefits is a complex one, and there are
a variety of issues surrounding this subject. For example, it has been argued that the
way compensation is structured within the NFL might induce an individual to play
while injured instead of seeking medical treatment. The oldest retired players might
make up a subset with exceptional financial and medical needs, because they (1)
might not have been protected as well as current players are; (2) might have received
medical care that, while the best available at the time, was not as effective as the care
available today; and (3) are not eligible for all of the benefits available to current
players. Another issue involves MTBI research and whether multiple concussions
might have long-term effects. The NFLPA proposed three legislative options in
2007. Other possibilities include establishing one or more ombudsman offices or
taking steps to mitigate the economic risk of injuries and disabilities. This report will
be updated as events warrant.

Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
The Game of Football and the Health of Players . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
The Nature of the Game of Football . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Health Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
NFL and NFLPA Benefit Programs and Plans . . . . . . . . . . . . . . . . . . . . . . . . . . 18
History of Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
How Benefits Are Funded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Benefits for Former Players . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
NFLPA Retired Players Department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Players Assistance Trust (PAT) Fund . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
The Alliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Other Efforts to Aid Former Players . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Selected Organizations and Websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Active Players’ Efforts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
NFL and NFLPA Health and Safety Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . 50
NFL Injury and Safety Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
NFL Cardiovascular Health Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
NFL Medical Research Grants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
NFL Mild Traumatic Brain Injury Committee . . . . . . . . . . . . . . . . . . . . . . . 53
NFL and NFLPA Education Efforts for Players . . . . . . . . . . . . . . . . . . . . . 54
NFLPA Medical Consultant and Performance Consultant . . . . . . . . . . . . . 55
NFL and NFLPA Joint Committee on Player Safety and Welfare . . . . . . . 56
Discussion of Selected Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Injuries and Financial Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Selected Challenges for Some Retired Players . . . . . . . . . . . . . . . . . . . . . . 74
Total and Permanent (T&P) Disability Benefit . . . . . . . . . . . . . . . . . . . . . . 76
Is There a Subset of Former Players with Exceptional Needs? . . . . . . . . . . 86
What Is Known about Injuries and Possible Long-Term Consequences? . . 92
Studies on Possible Long-Term Effects of MTBI . . . . . . . . . . . . . . . . 92
Susceptibility to an Additional MTBI . . . . . . . . . . . . . . . . . . . . . . . . . 97
Chronic Traumatic Encephalopathy (CTE) . . . . . . . . . . . . . . . . . . . . . 98
NFL’s Approach to MTBI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Funding for the Retirement Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
What Is the Extent of the NFLPA’s Capacity? . . . . . . . . . . . . . . . . . . . . . 112
Medical Care for Active Players . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Access to Medical Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Arrangements for Medical Care and Treatment . . . . . . . . . . . . . . . . . 114
Workers’ Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Possible Courses of Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
NFLPA’s Suggestions for Legislative Action . . . . . . . . . . . . . . . . . . . . . . 119

Establish Federal Standards for Workers’ Compensation . . . . . . . . . 120
Permit Unions to Manage Their Benefit Plans . . . . . . . . . . . . . . . . . 120
Eliminate the Requirement for the Disability Initial Claims
Committee (DICC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Other Suggestions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Mitigation of Economic Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Independent Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Data: Collection, Quality, and Access . . . . . . . . . . . . . . . . . . . . . . . . 124
Establish an Ombudsman Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Concluding Observations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Appendix A. Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Appendix B. NFL and NFLPA Studies Concerning Players’ Health . . . . . . . . 134
Planned or Ongoing Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
Appendix C. Members of the Mild Traumatic Brain Injury Committee and
Retired Player Study Investigators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
MTBI Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Retired Player Study Investigators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Appendix D. Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
List of Tables
Table 1. The NFL’s Major Television Rights Contracts, 2006-2013 . . . . . . . . . . 1
Table 2. Number of Players Listed on the NFL’s Injury Report, 2007 Season . . . 7
Table 3. NFL Players’ Injuries by Type of Injury, 1997-1999 . . . . . . . . . . . . . . . . 9
Table 4. Selected NFL-NFLPA Benefits as of October 2007 . . . . . . . . . . . . . . . 30
Table 5. Players Assistance Trust Fund Grants, by Grant Type, 1991-2007 . . . . 43
Table 6. Players Assistance Trust Fund Grants, by Year, 1991-2007 . . . . . . . . . 43
Table 7. NFL Charities’ Grants for Research Related to Players’ Health,
2003-2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Table 8. Signing Bonuses Among NFL Players, 1993-1997 . . . . . . . . . . . . . . . . 64
Table 9. Signing Bonuses Among NFL Players, 1998-2002 . . . . . . . . . . . . . . . . 66
Table 10. Signing Bonuses Among NFL Players, 2003-2007 . . . . . . . . . . . . . . . 68
Table 11. Range of Percentage of Total Players Who Received a Signing
Bonus, by Signing Bonus Amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Table 12. Total and Permanent Disability Payments by Category . . . . . . . . . . . . 78
Table 13. Selected Criteria for Football Degenerative and Inactive
Categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Table 14. Effect of 15-Year Threshold on Eligibility for
“Football Degenerative” Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Table 15. Number of Players Who Are Receiving or Have Received T&P
Benefits, as of October 23, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Table 16. Benefits Available to Players . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Table 17. Recipients of NFL Charities Grants for MTBI and Related Research,
2003-2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Former NFL Players: Disabilities, Benefits,
and Related Issues
Introduction1
Professional football, notably the National Football League (NFL), is the
favorite sport of many in the United States.2 Recognized by some as “America’s
most popular spectator sport,” the NFL’s “popularity has never been greater: in the
past 20 years, football has sharply widened its lead over baseball as America’s
favorite professional sport, according to a Harris Poll in December [2005]. Fans
choose football over baseball, basketball and auto racing combined....”3 The
popularity of the sport also is reflected in the league’s major television rights deals,
which are summarized in Table 1.
Table 1. The NFL’s Major Television Rights Contracts,
2006-2013
Network or Cable
Years Covered by
Average Annual
Total Rights Fee
Channel
the Contract
Value
CBS and Fox
2006-2011
$8.0 billion
$1.3 billion
NBC
2006-2011
$3.6 billion
$600 million
ESPNa
2006-2013
$8.8 billion
$1.1 billion
Total
$20.4 billion
$3.0 billion
Source: Sports Business Resource Guide & Fact Book, 2006 (Charlotte, NC: Street and Smith’s
Sports Group, 2005), p. E-120.
a. A comparable television rights deal between Major League Baseball and ESPN, for the period
2006-2013, has a total rights fee of $2.37 billion and an average annual value of $296 million.
(Sports Business Resource Guide and Fact Book, 2006, 2005, p. E-120.)
Throughout the documents that govern retirement and disability benefits,
“active” players are distinguished from inactive, or retired, players. In this context,
“active” players generally are those under contract to a club or between teams; the
1 This report was prepared at the request of the House Committee on the Judiciary.
2 A list of acronyms used in this report may be found at Appendix D.
3 Hoover’s, Inc., “National Football League,” Dec. 11, 2007, available at
[http://www.lexisnexis.com/]; and Steven Levingston, “NFL Plays Smash-Mouth Ball When
It Comes to Branding,” Washington Post, Feb. 5, 2006, p. A7.

CRS-2
term roughly corresponds to the bargaining unit under the CBA. The term “active
player” also can arise in distinguishing among categories of players who are
employed by teams. For example each team is permitted a maximum of 53 players
on its roster for a game. This limited roster comprises an Active list, not exceeding
45, and an Inactive list. However, “active players,” as used generally in this report
extends beyond roster players those players employed while in other categories,
injured reserve, for example.
Active and future players are represented by the NFL Players Association
(NFLPA), which is the sole and exclusive bargaining representative for players.4 The
average length of an NFL career is three and one-half seasons, and the average salary
(which may include other types of compensation; see below for additional
information) is $1.1 million.5 Including both vested (i.e., having earned a sufficient
number of “credited seasons” to qualify for retirement benefits) and nonvested
players, the number of retired (or former) players is approximately 13,000. Vested
players number approximately 7,900.6 Although, under the collective bargaining
agreement (CBA), the NFLPA does not represent former players, it does negotiate
with the NFL for benefits for retired players.7

Playing professional football can, for some individuals, exact a significant
physical, and, in some cases, mental, toll. Yet, the excitement of big hits is part of
the attraction of the sport. In 2003, ESPN introduced a segment, “Jacked Up,” that
featured the five biggest hits from the weekend’s games, except for plays that
4 National Football League and NFL Players Association, NFL Collective Bargaining
Agreement, 2006-2012, Mar. 8, 2006, p. 3. The term “future players” refers to individuals
who had been previously employed by an NFL team and who are seeking employment with
an NFL team; all rookie players, once they have been selected in the current year’s draft;
and all undrafted rookie players, once they begin negotiations with an NFL team. (Ibid.)
5 NFL Players Association, “FAQs: NFL Hopefuls FAQ,” available at
[http://www.nflpa.org/Faqs/NFL_HopefulsFaq.aspx] as of Jan. 14, 2008, on file with the
author. The NFL Players Association established a new website in Mar. 2008, replacing the
original url [http://www.nflpa.org], with this url: [http://www.nflplayers.com]. (NFL
Players Association, “Ready, Set, Click! NFLPA to Launch New Website This Month,”
Mar. 6, 2008, available at [http://www.nflplayers.com/user/content.aspx?fmid=178&lmid=
443&pid=310&type=n].) Following this change, some of the NFLPA documents obtained
from the previous website apparently are no longer readily accessible at the new website.
Citations for these documents include the date the author accessed and printed the relevant
document. However, some of these documents are pdf documents, which means that the
dates they were accessed via the previous NFLPA website do not appear on the document.
The citations for this particular group of documents notes the month and year they were
downloaded. Regarding documents obtained from the previous website that are accessible
at the new website, the current url is provided.
6 Letter from Eugene Upshaw, Executive Director, NFL Players Association, to Reps. John
Conyers, Jr., Lamar S. Smith, Linda T. Sanchez, and Christopher B. Cannon, Nov. 5, 2007,
p. 8.
7 A Supreme Court ruling stated that “the ordinary meaning of ‘employee’ does not include
retired workers....” (Allied Chemical & Alkali Workers of America, Local Union No. 1 v.
Pittsburgh Plate Glass Co., Chemical Division, 404 U.S. 157 (1971), at 392.)

CRS-3
resulted in an injury or a penalty.8 Television news broadcasts often carry video
replays of especially hard collisions. Some players achieve renown as “big hitters.”
Despite the popularity of the physical nature of the game, it is balanced by
concern for the players. One sports journalist has written of the game’s violence,
“Players live for it, fans love it, media celebrate it — and all bemoan its devastating
consequences. The brutal collision of bodies is football’s lifeblood, and the NFL’s
biggest concern.”9
For the purposes of this report, distinctions are made between injuries,
disabilities classified as such under the Bert Bell/Pete Rozelle NFL Player Retirement
Plan (“retirement plan”), disabilities generally, and chronic health problems. An
injury is damage that occurs to an individual’s body, in this case a professional
football player, such as an abrasion, or a sprained ankle, torn muscle, or concussion.
A retirement plan disability is a medical condition that qualifies as a disability under
the NFL and NFLPA retirement plan. (See below for additional information about
the different types of disabilities for which benefits are provided under the retirement
plan.) The term “disability” also may be interpreted more broadly to include any
inability or incapacity. Thus, a retired player who is incapable of performing one or
more particular activities or functions, but does not receive any retirement plan
disability benefits, also may be considered to be disabled.10 The phrase “chronic
health problems” refers to conditions or illnesses that interfere with the activities of
daily living, but do not rise to the level of rendering a player unable or incapable of
performing an activity or function. For example, as reported by the Los Angeles
Times in 2000, Joe Montana, former quarterback for the San Francisco 49ers, “does
not qualify for disability payments ... [and appears] to be living a healthy, active post-
career life, [but he] suffers from an aching knee that makes [playing] golf painful, a
numb foot that makes walking awkward and occasional blurred vision from too many
hits to the head.”11
Although the focus of this report is on former players, and their health problems
and benefits, the report also covers certain issues involving active players. The
health of retired players derives in part from the injuries and medical conditions (such
as excessive weight, if not obesity) that they may have experienced during their
playing days. Accordingly, some of the conditions, terms, or policies under which
active players perform might have some bearing on their current and long-term
health. The issue of former players and their health and benefits has received
considerable attention from Congress, including hearings in both chambers.
8 Tim Layden, “The Big Hit,” Sports Illustrated, July 30, 2007, p. 58.
9 Ibid., p. 53.
10 For example, a former player who is disabled but does not receive any disability benefits
might not have applied for benefits; might not be eligible for disability benefits; might have
applied and have his application pending; or might have applied, but had his application
denied.
11 Steve Springer, “After Care: Medical Benefits; Disability Payments Ease Pain; Unlike in
Years Past, Former Players Who Are Totally and Permanently Disabled Receive Monetary
Compensation,” Los Angeles Times, Jan. 25, 2000, p. D8.

CRS-4
The next section describes the physical nature of the game of football, injuries,
and health problems and is followed by a section on benefit programs and plans
available to former players. After an overview of other organizations’ efforts to aid
former players, this report examines the NFL’s and the NFL Players Association’s
health and safety initiatives, examines selected issues, and discusses possible courses
of action.
The Game of Football and the Health of Players

Introduction
Comprehensive data about the health of former players apparently are not
collected and maintained, either by the NFLPA or the NFL, or by a third party. The
NFLPA is not aware of “any source of general data on the current health” of the
7,900 former players who are vested.12 Individual teams may have some information,
but, apparently, the Retirement Plan Office does not.13
Neither the players association nor the league collects data on number or
percentage of players who retire because of an injury or injuries.14 The NFLPA
notes:
[Players] may leave the game for several reasons. Statistics about why NFL
players retire can be misleading. Most careers are not affected by a muscle or
bone problem that causes a person to be one-half of a second slower in the 40-
yard dash. In the NFL, that half-second could cost a player his job. The vast
majority of players who leave the NFL, including those who leave because of
injury, are in most respects quite healthy and capable of other employment.15
Although the last statement in this passage may be accurate, confirmation is difficult
due to the dearth of evidence, and possibly some of the individuals who are “quite
healthy” upon leaving the NFL might develop football-related disabilities later in life.
The NFL offers several possible reasons individuals retire from professional
football: “Players retire for many reasons: because they do not make the team,
because they wish to start their second career, because they lose the desire to play,
or because they wish to spend more time with their families.”16 Nevertheless, the
NFL has some information on this subject which suggests that, for the period 1994-
2004, at least 181 players retired for health reasons. This figure is 4% of the “4,362
players who earned a Credited Season” during the same period and who “appear to
12 Letter from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, p. 8.
13 Ibid., p. 7. The Retirement Plan Office is responsible for administering the retirement
plan which is part of the collective bargaining agreement.
14 Ibid., p. 13; Letter from Roger Goodell, Commissioner, National Football League, to
Reps. John Conyers, Jr., and Lamar S. Smith, Nov. 2, 2007, p. 9.
15 Ibid.
16 Ibid.

CRS-5
have retired.”17 The NFL was able to identify these 181 players because they
received additional compensation after they “did not pass their pre-season physical[s]
due to [injuries] sustained during the prior season and thus were unable to play.” Not
included in this count are players who decided to retire because of their injuries and
thus did not submit to a pre-season physical.
Without comprehensive, complete, detailed, and accurate data, including the
number and extent of all disabilities and chronic health problems, it is difficult to
know the health status, or employment or financial status, of all former players, and
not just those who already receive, in particular, disability benefits.18 As suggested
above, some former players may have chronic health problems or may suffer from
disabilities, as broadly construed, but do not receive any disability benefits from the
retirement plan. The absence of information about this group of retirees makes it
difficult to determine whether any of them do not receive sufficient assistance, and
also might hamper efforts to determine the effects or consequences of football-related
disabilities.

Despite the lack of data on the health of former players, however, descriptive
information can provide some insight into the nature of professional football and
football injuries, which, for some former players, might have long-term health
consequences.
The Nature of the Game of Football
Physical contact is integral to the game of professional football. For some,
though, the phrase “physical contact” is an inadequate description. Notably, Mike
Ditka, a former player and coach in the NFL, stated, during a congressional hearing,
that “[i]t is not a contact sport, it’s a collision sport.”19
Timothy Gay, a professor of physics at the University of Nebraska and author
of Football Physics: The Science of the Game, asks,
What is the force of that hit? Well, you’re talking about classical physics, which
puts us in the province of Isaac Newton: Force equals mass times acceleration.
What you come up with in this case is that each man exerts about 1,500 pounds
of force, or three quarters of a ton, on the other. Which is why they call football
a contact sport.20
17 Letter from Goodell to Reps. Conyers and Smith, p. 9.
18 In some cases, an individual’s health status and financial status may be related.
19 U.S. Congress, Senate Committee on Commerce, Science and Transportation, “Oversight
of the NFL Retirement System,” statement of Mike Ditka, unpublished hearing, 110th Cong.,
1st sess., Sept. 18, 2007, p. 99.
20 Layden, “The Big Hit,” pp. 55-56. See also Timothy Gay, Football Physics, The Science
of the Game (Emmaus, PA: Rodale Inc., 2004), pp. 35-36; and Gene Wojiechowski and
Chris Dufresne, “Life Expectancy Low, Some Say: Football Career Is Taking Its Toll on
NFL’s Players,” Los Angeles Times, June 26, 1988, available at
[http://www.lexisnexis.com/].

CRS-6
At Virginia Polytechnic Institute and State University (Virginia Tech), a mechanical
engineering professor put impact recorders in football players’ helmets in 2003. The
devices recorded 3,300 hits to the heads of players in 10 games and 25 practices. He
also found that “[a] typical skull absorbed 50 wallops measured at 40 times the force
of gravity....”21 Players collide during training camp, practice, pre-season, regular
season and post-season games.22 Some players tear muscles and ligaments, break
bones, and lose consciousness.23
Each week during the season, the NFL releases an injury report that lists, for
each team, players who are injured, the type or location of the injury (for example,
“concussion,” “knee,” or “ribs”), and the injured player’s status for the upcoming
game (for example, “out,” “questionable,” or “probable”).24 Table 2 includes data
for each week in the 2007 season. The data in this table may not provide an accurate
count of the number of injuries sustained by NFL players for the following reasons:
(1) only one type of injury or injury location was listed on the report, but some
players listed may have had more than one injury; (2) a player may not have reported
his injury or injuries to his team’s medical staff, and, hence, his name did not appear
on the report; (3) a player may have reported his injury or injuries to the medical
staff, but the type or severity of the injury or injuries did not preclude him from
playing; and (4) a player whose injury status kept him from playing in games for
more than one week could be listed on the injury report each week. More accurate
injury data are submitted to the NFL’s Injury Surveillance System (see below for
additional information) by each team’s medical staff.
21 Carl Prine, “Extra Pounds Cause Trouble Later in Life,” Pittsburgh Tribune-Review, Jan.
9, 2005, available at [http://www.pittsburghlive.com/x/pittsburghtrib/news/specialreports/
specialnfl/s_291051.html].
22 Carl Prine, “Bloody Sundays,” Pittsburgh Tribune-Review, Jan. 9, 2005, available at
[http://www.pittsburghlive.com/x/pittsburghtrib/news/specialreports/specialnfl/
s_291033.html].
23 Peter Carlson, “For the NFL’s Retirees: Know Pain, No Gain,” Washington Post, Aug.
21, 2007, p. C7; and Paul Gutierrez, “NFL Injuries; Pain Game,” Los Angeles Times, Jan.
25, 2000, available at [http://www.lexisnexis.com/].
24 According to a news article, “The [NFL’s] injury lists have roots in two mandates: State
workers’ compensation laws and federal reporting requirements force teams to record
injuries. Because a paper trail is needed to substantiate a potential on-the-job disability or
safety issue, broken bones, joint tears, ruptured muscles, head wounds and other ailments
are written down. NFL bylaws also require teams disclose to their opponents their players’
pre-game injury status so coaches can prepare strategies.” (Prine, “Bloody Sundays.”)
Regarding an injured player’s status, Prine reported that “even a player marked ‘probable’
for Sunday’s game has a ‘serious’ injury, much as a bad fall or a degenerative bone
condition would be considered serious on a workers’ compensation filing. ‘As a fan, maybe
you don’t think it’s serious because the player is playing, but [the injury] can still be
serious,’ said Dr. Derek Jones, one of the nation’s foremost orthopedic surgeons at the
Ochnser Clinic in New Orleans.” (Ibid.)

CRS-7
Table 2. Number of Players Listed on the NFL’s Injury Report,
2007 Season
Week During the Season
Number of Playersa
Percentage of Playersb
1
132
8%
2
167
10%
3
202
12%
4
208
12%
5
207
12%
6
179
11%
7
190
11%
8
159
9%
9
188
11%
10
185
11%
11
195
11%
12
181
11%
13
198
12%
14
211
12%
15
207
12%
16
203
12%
17
216
13%
Source: National Football League, “Injuries,” available at [http://www.nfl.com/injuries].
a. These figures do not include any player who was listed on a team’s injury report, but for whom the
entry in the “Injury” column was “Appendicitis,” “Coach’s Decision,” “Migraine,” “Personal,”
“Personal Decision,” “Personal Reason,” “Team decision,” or “Illness.”
b. Percentages have been rounded.
Aside from weeks one and eight, at least 10% of NFL players are identified each
week as being injured. The relatively small variation in the percentage of players
identified as being injured each week throughout a 17-game season — 10% to13%
— suggests, despite questions about the accuracy of the data, that a fairly consistent
number of players are injured throughout the season.
A journalist for the Pittsburgh Tribune-Review conducted an analysis of four
years of data culled from the NFL’s weekly injury reports, interviewed 200 current
and former players, coaches, and managers about injuries, and reviewed medical
literature. A summary of his findings is as follows:

CRS-8
In the 2000 through the 2003 seasons, NFL players racked up 6,558 injuries.
More than half the athletes are hurt annually, with the number spiking at 68% in
2003-04, according to the NFL’s weekly injury reports.
Defenders are injured more than their foes on the offense. A defensive back
alone is 30 percent more likely to get hurt than a quarterback, even though a
passer touches the ball on every possession. Two out of three cornerbacks and
safeties suffer injuries in the NFL annually, and half of those will suffer a
second, unrelated injury before the Super Bowl.
Quarterbacks, tight ends, wide receivers, safeties and cornerbacks routinely
suffer high rates of brain concussions and spine injuries that could trigger
paralysis, dementia, depression and other ailments later in life. During typical
four-year careers, one of every 10 NFL receivers experiences a concussion. On
average, seven pro football players a week face potentially life-altering head,
spine or neck trauma.25
Additionally, the news article noted that, during the four-year period studied, 1,205
players had knee injuries; 652 sustained head, spine, or neck trauma; 683 injured
their hamstring and groin muscles; and 928 broke or sprained their ankles.26
Reportedly, the “2003 NFL injury rate was nearly eight times higher than that of any
other commercial sports league, according to the U.S. Department of Labor — and
that includes the National Hockey League, the National Basketball Association, and
professional auto racing.”27
Another newspaper, the Los Angeles Times, also used the NFL’s weekly injury
reports to compile data for several seasons, 1997-1999. In 1997, 335 players were
sidelined for 937 games; in 1998, 398 players sat out 1,340 games; and, in 1999, 364
players did not play in 1,061 games.28 Table 3 shows the types of injuries sustained
by NFL players for these three years. The data in this table are not comparable to the
data provided in Table 2. A key difference between the two datasets is that the Los
Angeles Times researcher who compiled the data found in Table 3 tracked individual
players.29 Nevertheless, some of the same caveats that apply to Table 2 also might
apply to Table 3. That is, the data in Table 3 may not provide an accurate count of
the number of injuries sustained by NFL players for the following reasons: (1) only
one type of injury or injury location was listed on the report, but some players listed
may have had more than one injury; (2) a player may not have reported his injury or
25 Prine, “Bloody Sundays.”
26 Ibid.
27 Ibid.
28 Gutierrez, “NFL Injuries; Pain Game.”
29 Specifically, he “tracked every player who suffered an injury during the 1997, ‘98, and
‘99 seasons. Those players who were sidelined for a game or more because of injury were
logged, as were the number of games they were sidelined and the types of injuries. Players
who were injured in the previous season or in the exhibition season and missed games the
next season ... were not counted.” (Houston Mitchell, “NFL Injuries; Injury Report;
Methodology,” Los Angeles Times, J an. 25, 2000, availabl e at
[http://www.lexisnexis.com/].)

CRS-9
injuries to his team’s medical staff and hence his name did not appear on the report;
(3) a player may have reported his injury or injuries to the medical’s staff, but the
type or severity of the injury or injuries did not preclude him from playing.
Table 3. NFL Players’ Injuries by Type of Injury, 1997-1999
Type of Injury or
1997a
1998a
1999a
Illness
Abdomen
2
6
1
1%
1%
<1%
Abrasions
0
0
1
<1%
Achilles tendon
3
3
5
1%
1%
1%
Ankle
50
54
52
14%
13%
14%
Arm
5
5
4
1%
1%
1%
Back
12
23
9
3%
5%
2%
Biceps
0
4
1
1%
<1%
Blood clot
0
0
1
<1%
Buttocks
1
0
0
<1%
Calf
4
10
7
1%
2%
2%
Chest
0
5
2
1%
1%
Concussion 5
5
11
1%
1%
3%
Elbow
7
4
5
2%
1%
1%
Ear
1
0
0
<1%
Eye
3
2
0
1%
<1%
Face laceration
0
0
1
<1%

CRS-10
Type of Injury or
1997a
1998a
1999a
Illness
Finger
1
4
1
<1%
1%
<1%
Foot
8
23
19
2%
5%
5%
Groin
12
14
10
3%
3%
3%
Hamstring
29
35
30
8%
8%
8%
Hand
12
9
2
3%
2%
1%
Head
3
2
1
1%
<1%
<1%
Heel
1
0
0
<1%
Hernia
1
0
1
<1%
<1%
Hip
6
2
4
2%
<1%
1%
Jaw
2
2
1
1%
<1%
<1%
Kidney
0
1
0
<1%
Knee
104
131
122
30%
31%
33%
Leg
14
7
7
4%
2%
2%
Liver
0
0
1
<1%
Neck
11
13
14
3%
3%
4%
Nose
1
0
0
<1%
Pelvis
1
0
0
<1%
Quadriceps
3
2
7
1%
<1%
2%

CRS-11
Type of Injury or
1997a
1998a
1999a
Illness
Ribs
6
4
4
2%
1%
1%
Shin
0
1
0
<1%
Shoulder
22
35
31
6%
8%
8%
Thigh
3
1
0
1%
<1%
Throat
0
0
1
<1%
Thumb
5
4
4
1%
1%
1%
Toe
5
3
6
1%
1%
2%
Triceps
1
2
1
<1%
<1%
<1%
Wrist
3
3
0
1%
1%
Total
347
419
367
Source: Houston Mitchell, “NFL Injuries; Injury Report; Methodology,” Los Angeles Times, Jan. 25,
2000, available at [http://www.lexisnexis.com/].
a. Percentages have been rounded.
According to Table 3, players sustained 43 different types of injuries. Four
types of injuries accounted for 50% of the injuries in each year: knee, ankle,
hamstring, and shoulder. The breakdown for each of these injuries, by year, is as
follows:
! Knee: 30%, 31%, and 33%
! Ankle: 14%, 13%, and 14%
! Hamstring: 8% each year
! Shoulder: 6%, 8%, and 8%
Given the focus on mild traumatic brain injury (MTBI, or concussions) in 2007, and
the related anecdotal evidence on the frequency of concussions, it is notable that only
21 concussions were recorded for this three-year period (1997-1999). Concussions
accounted for 1% of injuries in 1997 and in 1998, and 3% in 1999.
For some players, the injuries they sustain playing in the NFL might lead to
disabilities later in life. David Meggyesy, a former player and the director of
NFLPA’s San Francisco office, reportedly referred to post-NFL injuries as “‘the

CRS-12
elephant in the room that no one wants to say is in the room.... Everybody walks
away with an injury.... You just don’t see that being done to the human body and not
think there are going to be consequences later in life.’”30 Echoing Meggyesy’s
comments, a former president of the NFLPA, Trace Armstrong, offered his
observations of other former players: “You go to our retired players’ conventions ...
and some of these guys don’t look so good. Young men, onetime great athletes, but
they don’t move around so well.”
Health Problems
Although accurate, complete, comprehensive, and detailed data about former
and active players are necessary to construct a comprehensive picture of their health,
the following information is useful for illustrating some of the health problems
football players might experience, whether as active players or as retirees.
An obvious feature of most football players is their size. From 1985 through
2005, the average weight of a player in the NFL grew by 10% to an average of 248
pounds. At the heaviest position, offensive tackle, the average weight of players has
increased from 281 pounds in the mid-1980s to 318 pounds in 2005.31 As of 2005,
552 players weighed 300 pounds or more, which is 33% of all active players, and 82
other players weighed between 295 and 299 pounds.32
Not only are football players large, but some of them also may be classified as
obese. Joyce B. Harp and Lindsay Hecht calculated the body mass index (BMI) of
NFL players active during the 2003-2004 season and reported these findings:33
! 97% of the players had a BMI of 25 or greater.
! 56% had a BMI of 30 or greater. This was 32 percentage points
higher than the percentage of 20- to 39-year-old men who had
comparable BMIs in the 1999-2002 National Health and Nutrition
Examination Survey (NHANES).34
! 26% of the players had a BMI of 35 or greater.
30 David Steele, “Adding Insult to Injury,” San Francisco Chronicle, Sept. 1, 2002, available
at [http://sfgate.com].
31 Thomas Hargrove, “Heavy NFL Players Twice as Likely to Die Before 50,” Espn.com,
Jan. 31, 2006, available at [http://sports.espn.go.com/nfl/news/story?id=2313476].
32 Mark Maske and Leonard Shapiro, “NFL Is Soul Searching After Herrion’s Death,”
Washington Post, Aug. 25, 2005, p. E8.
33 For this study, “body mass index (BMI) was calculated for each of the players as weight
in kilograms divided by height in meters squared, as was mean BMI for each team and
position across all 32 teams and a frequency distribution of BMI for all players.” (Joyce B.
Harp and Lindsay Hecht, “Obesity in the National Football League,” Journal of the
American Medical Association, vol. 293, no. 9, Mar. 2, 2005, p. 1061.)
34 Information about the National Health and Nutrition Examination Survey is available at
[http://www.cdc.gov/nchs/nhanes.htm].

CRS-13
! 3% of the players had a BMI of 40 or greater. This percentage was
similar to the percentage (3.7%) of 20- to 39-year-old men who had
comparable BMIs in the 1999-2002 NHANES.
! Cornerbacks and defensive backs had the lowest mean BMI (26.8).
! Guards had the highest mean BMI (38.2).35
In this study, “body mass index was classified according to the National Institutes of
Health guideline: normal weight (BMI 18.5-24.9), overweight (25-29.9), obese class
1 (30-34.9), obese class 2 (35-39.9), and obese class 3 ($40).”36 These data show
that slightly more than half of the players were obese, with 26% having a BMI that
“qualifie[s] as class 2 obesity.”37 The authors concluded their article with the
following comment:
Although measurements of body composition are needed to determine the source
of the increased weight, it is unlikely that the high BMI in this group, particularly
in the class 2 obesity range, is due to a healthy increase in muscle mass alone.
The high number of large players was not unexpected given the pressures of
professional athletes to increase their mass. However, it may not be without
health consequences. A recent study described increased sleep-disordered
breathing in professional football players, particularly those with a high BMI;
linemen, who had the highest BMIs, also had higher blood pressures than did
other players. The high prevalence of obesity in this group warrants further
investigation to determine the short- and long-term health consequences of
excessive weight in professional as well as amateur athletes.38
Dr. Elliott Pellman, former medical advisor/liaison to the NFL Commissioner,
reportedly critiqued the Harp and Hecht article by saying: “‘[The BMI] is okay if
you’re an actuary for life insurance.... But medically, we don’t define obesity that
way. It’s not designed for people that large. The study the [NFL] commissioner
ordered will do a lot more than take heights and weights off the Internet. The data
must be gathered in a scientific way.’”39
35 Harp and Hecht, “Obesity in the National Football League,” pp. 1061-1062.
36 Ibid., p. 1061.
37 Ibid., p. 1062.
38 Ibid., p. 1062.
39 Maske and Shapiro, “NFL Is Soul Searching After Herrion’s Death,” p. E8. It is unclear
whether the subject of obesity will be part of the NFL’s study on cardiovascular health, or
it will be the subject of a separate study. See Appendix B for a list of planned or ongoing
studies. Elliot Pellman was medical advisor/liaison to the NFL Commissioner for the period
2001-2006. (Elliot J. Pellman, “Curriculum Vitae,” provided by the House Committee on
the Judiciary to the author on Nov. 6, 2007, p. 3.) Dr. Pellman served as the Chairman of
the NFL Committee on Mild Traumatic Brain Injury (MTBI) from 1994 through 2007. His
residencies and fellowship were in the fields of internal medicine and rheumatology. He
continues to serve on the MTBI Committee, and he also serves on the Alliance for NFL
Retired Football Players (member, 2007-present), the NFL’s Foot and Ankle Committee
(advisor, 2005-present) and Cardiovascular Health Committee (advisor, 2004-present), the
NFL-NFLPA Joint Committee on Player Safety (member, 2001-present), the NFL’s Injury
and Safety Panel (advisor, 1995-present). Previously, he served as a member of the National
(continued...)

CRS-14
Reportedly, some NFL linemen have a provision in their contracts saying they
agree to maintain their size.40 In Article XXIV, Section 7(c) of the CBA, which
addresses financial incentives in players’ contracts, examples of incentives that are
considered “within the sole control of the player” include “weight bonuses.”41
“Weight bonuses” is open to interpretation. For example, a player may be required
to not exceed a certain weight or not to fall below a certain weight. Reportedly, Gene
Upshaw, executive director of the NFLPA, said, in 2002, that the players association
and the league had been discussing “how to deal with weight-loss demands by
coaches. Is science involved? What factors do height and weight play? How long
does it take the player to lose it?”42 It is unclear, though, whether this reference to
weight loss is related to the possibility of a weight contract clause.
Obesity itself, plus simply being overweight, can lead to other health problems,
both indirectly and directly. Players who have retired from the NFL may have
difficulty decreasing their weight and staying in shape, particularly if they suffer from
other health problems that preclude or limit their physical activity.43 Kevin
Guskiewicz, research director of the Center for the Study of Retired Athletes
(CSRA), University of North Carolina at Chapel Hill, as quoted in the New York
Times, adds pain to the equation and describes a possible chain of events for former
players: “What happens is that the retired athlete can’t exercise because of the
injuries he’s sustained and the pain he is in, and that leads to higher weight,
depression, bad eating habits, high blood pressure and so on.”44
Sleep apnea and cardiovascular disease (CVD) are examples of two health
problems associated with excess weight. A 2003 study by SleepTech Consulting
Group found that 34% of offensive linemen suffered from sleep apnea.45 As reported
by the New York Times, an associate team physician with the New York Giants, Dr.
Allan Levy, describes what some NFL players might experience:
The problem with sleep apnea is in the neck. A 17 ½-inch neck is usually where
the problem begins. When they sleep, the muscles relax in the body. Now the
39 (...continued)
Football League Physicians Society’s executive committee, from 1994 through 2003. (Ibid.,
pp. 1-5.)
40 Prine, “Extra Pounds Cause Trouble Later in Life.”
41 National Football League and NFL Players Association, NFL Collective Bargaining
Agreement, 2006-2012, p. 109.
42 Thomas George, “Care by Team Doctors Raises Conflict Issue,” July 28, 2002, available
a t [ h t t p : / / q u e r y . n y t i m e s . c o m / g s t / f u l l p a g e . h t m l ? r e s =
990DEFDE173BF93BA15754C0A9649C8B63].
43 Ibid.
44 Harvey Araton, “Stealth Killer Puts Doctor on Mission with N.F.L.,” New York Times,
May 8, 2007, available at [http://query.nytimes.com/gst/fullpage.html?res=
9C02EED71631F93BA35756C0A9619C8B63&n=Top/News/Sports/Columns/Harvey%
20Araton]. Information about the Center for the Study of Retired Athletes may be found at
[http://www.csra.unc.edu/index.htm].
45 Prine, “Extra Pounds Cause Trouble Later in Life.”

CRS-15
weight of their neck clasps down on their airway. They stop breathing. They
momentarily wake up, then the cycle starts over again, and they never get into
deep sleep. They develop heart disease and hypertension. Sleep apnea is a
killer. One of the kids that played for us, we did a sleep study on [him], [he] had
440 awakenings during the night.46
Dr. Arthur Roberts, a cardiac surgeon who played in the NFL for three years,
summarized the cardiovascular risk for professional football players. His summary,
which was included in a Washington Post news article, follows:
The real problem is what’s happening inside these men to their cardiovascular
risk factors. The combination of large body size is associated with increased risk
factors for diabetes and hypertension, which lead to so many other problems.
Doctors have learned over the last 30 years that so many bad outcomes are
related to cardiovascular problems that might have been avoided .... Cardiac
arrest in the locker room is tragic but, thank God, a rare event .... But many of
the risk factors that are in these players’ bodies are not apparent now but will be
apparent later in life. We have to shift the pendulum and evaluate and educate
the younger players, make it a total process. With retired players we’re finding
high cholesterol and high blood pressure. We already know sleep apnea is
associated with heart arrhythmia and hypertension. You have a lot of risk factors
building in players. We have to make them aware and start educating them on
how to take care of themselves to avoid problems later on. We have the
technology to do it. We have a support system of doctors and hospitals involved
in this study willing to do it. It’s now a matter of getting players to buy into it.47
Roberts was referring to a study of past and present players involving, among other
things, the consequences of excess weight for cardiovascular health.48 In contrast,
a study designed to assess whether there is a link between playing professional
football and reduced risk later in life for CVD, osteoporosis, and higher muscle mass
reached an encouraging conclusion:

In this small [16 former NFL players] sample of older men, former successful
professional athletes who remained physically active in middle age have a
favorable body composition and reduced risk factors for CVD and osteoporosis
compared with health age-and BMI-matched older men.49
The findings of this study do not necessarily contradict Kevin Guskiewicz’s comment
above. This study included former players “who remained physically active in
46 Clifton Brown, “Ex-Players Dealing With Not-So-Glamorous Health Issues,” New York
Times, Feb. 1, 2007, available at [http://query.nytimes.com/gst/fullpage.html?res=
9D0CEFDB153FF932A35751C0A9619C8B63&n=Top/Reference/Times%20Topics/
People/B/Brown,%20Clifton].
47 Maske and Shapiro, “NFL Is Soul Searching After Herrion’s Death,” p. E8.
48 Ibid.
49 Nicole A. Lynch, Alice S. Ryan, Joyce Evans, Leslie I. Katzel, and Andrew P. Goldberg,
“Older Elite Football Players Have Reduced Cardiac and Osteoporosis Risk Factors,”
Medicine & Science in Sports & Exercise, 2007, p. 1124.

CRS-16
middle age,” while Guskiewicz was referring to retired players who are unable to
exercise because of injuries sustained during their NFL careers.
Responding to a request from the NFLPA, the National Institute for
Occupational and Safety and Health (NIOSH) conducted a mortality study in the
early 1990s of the rate and causes of death of NFL players.50 The study found the
following:
! Former offensive and defensive linemen “had a 50% greater risk of
cardiovascular disease than the general population.”51
! Linemen “had a 3.7 times greater risk of cardiovascular disease”
than players in other positions.52
Possibly lending credence to questions about the size of players, the authors noted
that “[i]t is not possible from this analysis to determine specifically what it is about
the linemen, besides BMI, that contributes to this increased risk.”53
As described above, players sustain hits to the head, which may or may not
result in a mild traumatic brain injury (MTBI) or concussion. Reportedly, league data
show that approximately 100 players a year sustain concussions.54 (For more
information on MTBI, see below, in the “Discussion of Selected Issues” section.)
A study that focused on the long-term effect of concussions, however, also
reported information about other health problems experienced by former players.
The researchers found, by questioning 2,488 former NFL players, that 22% had knee
surgery and 10% had back or disc surgery after their careers ended.55 In response,
the NFL’s medical advisor/liaison reportedly said that there is little credible research
on whether playing football leads to serious medical problems later in life.56

50 A January 2006 news article reported that Dr. Sherry Baron, co-author of the 1994 study,
was planning to repeat her study of mortality rates within the NFL. (Thomas Hargrove,
“Compared to Baseball, Football Players Die Younger,” Espn.com, Jan. 31, 2006, available
at [http://sports.espn.go.com/nfl/news/story?id=2313520].) The status of the planned study
is not known.
51 Letter from Sherry Baron, M.D., M.P.H., and Robert Rinsky, U.S. Department of Health
and Human Services, National Institute for Occupational Safety and Health, to Frank
Woschitz, National Football League Players Association, Jan. 10, 1994, p. 4. This letter is
popularly known as the “NFL mortality study.”
52 Ibid., p. 4.
53 Ibid., p. 4.
54 Peter Keating, “Doctor Yes,” ESPN.com, Oct. 28, 2006, available at
[http://sports.espn.go.com/espn/print?id=2636795 &type=story].
55 Ellen E. Schultz, “A Hobbled Star Battles the NFL,” Wall Street Journal, Dec. 3, 2005,
p. A2.
56 Ibid., pp. A2-A3.

CRS-17
A study of depression and pain experienced by former NFL players also
surveyed them about the most common problems they experience in retirement. The
results, “in descending order of frequency as quite or very common” were: “difficulty
with pain (48%), loss of fitness and lack of exercise (29%), weight gain (28%),
trouble sleeping (28%), difficulty with aging (27%), and trouble with transition to life
after professional football (27%).”57 Regarding the thrust of the study, the study’s
authors wrote:
Although pain and depression are commonly comorbid in the general population
..., the frequency with which retired professional football players report difficulty
with pain seems to put them at additional risk of both developing depression and
experiencing associated difficulties with retirement. The high level of
psychosocial dysfunction and significant barriers to receiving help put a small
but important subgroup of all retired NFL players at significant risk of adverse
life events and disability, almost certainly including an increased risk of
suicide.... Retired professional football players experience depressive symptoms
at a rate that is similar to that found in the general population, presumably with
a corresponding rate of clinical depression. They bear an additional burden of
substantial chronic pain. Depressive symptoms and pain interact to result in a
strong correlation with self-report perceptions of the risk of sleeping problems,
difficulty with aging, loss of fitness and lack of exercise, financial problems, and
concerns about their use of prescription and recreational drugs and alcohol.58
What, if any, relationship exists between playing professional football and
mortality is unclear. The 1994 NIOSH study mentioned above found that
professional football players had “a 46% lower overall mortality rate than the general
United States male population with a similar age and race distribution.”59 A review
of data on the mortality of those who played football, and those who played baseball,
a sport with less physical contact. Deceased players from both sports born before
1955”were about equally likely to suffer an early death.”60 However, differences
between these two groups of athletes did appear for players born after 1955.
! At least 130 of the 8,961 football players and 31 of the 4,382
baseball players born after 1955 are known to have died. That is,
1 in every 69 football players and 1 in every 154 baseball players
born after 1955 have died.
! The most common cause of death for baseball players was accidents;
only one-third died of medical causes. Over half (52%) of the
deceased football players “succumbed to conditions such as coronary
57 Thomas L. Schwenk, Daniel W. Gorenflo, Richard R. Dopp, and Eric Hipple, “Depression
and Pain in Retired Professional Football Players,” Medicine & Science in Sports and
Exercise, 2007, pp. 600-601.
58 Ibid., pp. 603-604.
59 Letter from Baron and Rinsky to Woschitz, p. 4.
60 Thomas Hargrove, “Compared to Baseball, Football Players Die Younger.”

CRS-18
disease, stroke and cancer — diseases known to be more common
among obese people.”61
! “The deceased baseball players averaged 192 pounds during their
athletic careers while the dead football players averaged 238 pounds.
Football players who died of medical causes averaged 248
pounds.”62
Complete, detailed, comprehensive, and accurate data are needed to construct
a profile of the health of active players and former players. Furthermore, this type
of initiative potentially could facilitate efforts to determine what links exist, if any,
between injuries sustained as an active player and chronic health problems and
disabilities (as broadly construed) experienced as a retired player.
NFL and NFLPA Benefit Programs and Plans
History of Benefits
Both the league and the players association are involved in the funding and
provision of benefits to former players as well as active players. Most of the benefits
for former players are administered by joint boards “to which the NFLPA and the
NFL each appoint three voting members. The day-to-day administration of these
jointly-trusteed benefits occurs at the ‘Plan Office’ in Baltimore ....” That is, neither
the NFLPA nor the NFL administers certain benefits, such as the benefits included
in the retirement plan, although the NFL is the sole administrator for severance pay
and post-career health insurance.63
Although the name and composition of the league has changed over the years,
the league was formed in 1920, and adopted its current name in 1922.64 The NFL
Players Association was founded a number of years later, in 1956.
The following history of selected events shows the evolution of benefits for NFL
players. Events that are not directly related to the establishment or enhancement of
benefits are included to provide context or background information. Such events
may include strikes, lockouts, and lawsuits, which are included for the period 1987-
1993, when several events and decisions culminated in significant changes in
benefits. However, since this is not a history of labor relations between the league
and the players association, the chronology does not necessarily include all of the
labor-management issues or milestones.
61 Ibid.
62 Ibid.
63 Ibid., p. 29.
64 The NFL as it exists today was created through a merger in 1966 with another league, the
American Football League, which was formed in 1959.

CRS-19
! 1958. Team owners created “a benefit plan that included
hospitalization, [and] medical and life insurance with a plan for
retirement benefits at age 65.”65
! 1960s. “Players pushed through pension coverage [for] a group of
110 players who were in the league in 1959, when benefits were
introduced. Life insurance and health coverage benefits were
improved and, for the first time, two player reps [representatives]
were designated to sit on the Retirement Board.”66
! 1962. The NFLPA obtained the first pension agreement, known as
the Bert Bell NFL Player Retirement Plan. The plan does not
include players who left the game before 1959 (known as the “pre-
59ers”).67
! 1966. The Commissioner of the NFL announced that the NFL and
American Football League (AFL) will merge into one league.
! 1968. The NFLPA, which represented players on only 16 of the 26
teams (the AFL Players Association represented players on the
remaining 10 teams), “proposed new pension demands ....” A
lockout is followed by a brief strike, and eventually the parties
agreed to what was the first CBA, which was effective from July 15,
1968, through February 1, 1970.68 Negotiations resulted in “a
minimum salary of $12,000, better pay for exhibitions, and a
doubling of the annual pension-fund contribution to $3 million.”69
The NFLPA demands included a retirement age of 45; but, the
retirement age in the CBA was set at age 65.70
! 1970. The AFL Players Association and the NFL Players
Association merged and retained the latter’s name. The NFLPA was
65 NFL Players Association, “About Us: NFLPA History,” n.d., available at
[http://www.nflpa.org/AboutUs/NFLPA_History.aspx] as of Oct. 2, 2007, on file with the
author.
66 Ibid.
67 NFL Players Association, “History of Retirement and T&P Benefits for NFL Players,”
n . d . , a v a i l a b l e a t [ h t t p : / / n f l p a . o r g / p d f s / N e w s A n d E v e n t s /
History_of_the_NFLPA%E2%80%99s_Retired_ Player_Benefits.pdf], downloaded Sept.
2007, on file with the author.
68 NFL Players Association, “About Us: NFLPA History”; The Business of Football 2001
(Carmel, CA: Paul Kagan Associates, Inc., 2001), p. 392.
69 Stephen Fox, Big Leagues, Professional Baseball, Football, and Basketball in National
Memory (Lincoln, NE: University of Nebraska Press, 1994), p. 425.
70 The Business of Football 2001, p. 393.

CRS-20
certified as a union.71 The American Football League (AFL) and the
NFL merged and retained the latter’s name. “The Players
Negotiating Committee and the NFL Players Association announced
a four-year agreement guaranteeing approximately $4,535,000
annually to player pension and insurance benefits.... The owners
also agreed to contribute $250,000 annually to improve or
implement items such as disability payments, widows’ benefits,
maternity benefits, and dental benefits.”72 Players also were given
the “right to meaningful representation on the Retirement Board, and
the right to impartial arbitration of injury grievances.”73 Total and
permanent (T&P) disability benefits and line-of-duty (LOD)
disability benefits were established.74 The pension plan was revised
and set up in its present structure. Monthly pension is based on the
number of years an individual plays football, not on the amount of
his salary.75
! 1973. A nonprofit organization, NFL Charities, was created “to
support education and charitable activities and to supply economic
support to persons formerly associated with professional football
who were no longer able to support themselves.”76
! 1974-1976. NFL and NFLPA played three seasons without a CBA.77
! 1977. The NFL Management Council and the NFLPA ratified a
CBA which continued “the pension plan — including years 1974,
1975, and 1976 — with contributions totaling more than $55
million.... The agreement ... reduced pension vesting to four years
... [and] improved insurance, medical, and dental benefits.”78
Specifically, Group Insurance was established.79 Players were
permitted to get a lump sum “early payment benefit” from their
pension; the lump sum equaled 25% of their pension.80
71 NFL Players Association, “About Us: NFLPA History.”
72 National Football League, “History, 1961-1970,” n.d., available at [http://www.nfl.com/
history/chronology/1961-1970].
73 NFL Players Association, “About Us: NFLPA History.”
74 Letter from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, p. 4.
75 NFL Players Association, “History of Retirement and T&P Benefits for NFL Players.”
76 National Football League, “History, 1971-1980,” n.d., available at [http://www.nfl.com/
history/chronology/1971-1980].
77 The Business of Football 2001, p. 394.
78 National Football League, “History, 1971-1980.”
79 Letter from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, p. 4.
80 NFL Players Association, “History of Retirement and T&P Benefits for NFL Players.”

CRS-21
! 1982. The strike-shortened season resumed after the CBA was
ratified on November 21-22. The CBA included, among other
things, increases in players’ medical, insurance, and retirement
benefits; and a severance pay system.81 Players also gained rights
related to their medical care: the right to a second opinion, the “right
to select a surgeon for injury-related operations, and the right to
inspect their club medical records.”82
! 1987. The 1982 CBA expired. The 1987 season included a strike,
the use of replacement players, the NFLPA filing an antitrust lawsuit
against the NFL and then filing charges with the National Labor
Relations Board (NLRB), alleging unfair labor practices.83 A
“special payment program was adopted to benefit nearly 1,000
former NFL players who participated in the League before the
current Bert Bell NFL Pension Plan was created and made
retroactive to the 1959 season. Players covered by the new program
spent at least five years in the League and played all of part of their
career prior to 1959. Each vested player would receive $60 per
month for each year of service in the League for life.”84 Players
continued to play through the 1993 season without a new CBA.
! 1987 and 1988. The owners agreed to allow benefit credits to accrue
at the then-rate of $150 per Credited Season.85
! 1989. A court ruling in the NFLPA’s antitrust lawsuit suggested that
“players had to choose between being a union and using their right
to strike under labor laws, or relinquishing their union rights and
[pursuing] their antitrust rights as individuals in court.” Players
ratified a decision for the NFLPA to decertify as a union, which
freed the players to pursue their antitrust rights.86 Team owners
refused to allow continued accruals of benefit credits. Instead,
owners created their own plan, called the “Pete Rozelle NFL Player
Retirement Plan.” The Rozelle plan was similar to the Bell plan,
“except that it [Rozelle plan] was run totally by the owners and had
81 National Football League, “History, 1981-1990,” n.d., available at [http://www.nfl.com/
history/chronology/1981-1990]; Peter King, “The Surreal Strike of 1987,” Sports Illustrated,
Oct. 15, 2007, p. 22; NFL Players Association, “About Us: NFLPA History”; Stephen Fox,
Big Leagues, Professional Baseball, Football, and Basketball in National Memory (Lincoln,
NE: University of Nebraska Press, 1994), p. 426; Letter from Upshaw to Reps. Conyers,
Smith, Sanchez, and Cannon, p. 4.
82 NFL Players Association, “About Us: NFLPA History.”
83 Ibid.; The Business of Football 2001, p. 395.
84 National Football League, “History, 1981-1990.”
85 NFL Players Association, “History of Retirement and T&P Benefits for NFL Players,” p.
4.
86 NFL Players Association, “About Us: NFLPA History.”

CRS-22
no player trustees.”87 By comparison, the union had the right to
appoint three of the Bert Bell Plan’s six voting trustees. The owners
refused “to make further contributions [to the Bell Plan], and the
trustees appointed by the union ... sued the trustees appointed by the
owners.”88
! 1990. The NFLPA was re-formed as a professional association. Its
goal was to “pursue litigation on behalf of individual players....”89
The change in status of the NFLPA “caused a rapid domino effect in
court cases.” For example, the NLRB awarded back pay to 1,400
players prevented from playing for one week after they ended their
strike in 1987; a case filed in 1990 “resulted in a jury awarding
damages to players; and the 1989 Brown v. NFL case awarded $30
million to practice squad players....”90
! 1992. “The NFL agreed to provide a minimum of $2.5 million in
financial support to the NFL Alumni Association and assistance to
NFL Alumni-related programs. The agreement included
contributions from NFL Charities to the Pre-59ers and Dire Need
Programs for former players.”91
! 1993. The NFL and the players association signed a seven-year
CBA, “which guarantee[d] more than $1 billion in pension, health,
and post-career benefits for current and retired players....”92
Specifically, the agreement provided for free agency; gave players
a guaranteed percentage of the gross revenues; retroactively
increased pre-59ers’ pensions by 30% and all other players’ pensions
by 40%; added pre-59ers to the Bert Bell Pension Plan (which added
906 players to the plan); decreased the vesting requirement to three
credited seasons; and established the Retiree Medical benefit,
Second Career Savings Plan, and Total and Permanent (T&P)
Disability benefits.93 Additionally, “WWII years were included for
87 NFL Players Association, “History of Retirement and T&P Benefits for NFL Players,” p.
4.
88 Ibid.
89 NFL Players Association, “About Us: NFLPA History.”
90 The Business of Football 2001, p. 396.
91 National Football League, “History, 1991-2000,” available at [http://www.nfl.com/
history/chronology/1991-2000].
92 Ibid.
93 NFL Players Association, “About Us: NFLPA History”; NFL Players Association,
“Recent Pensions & Disability Improvements Timeline,” n.d., available at
[http://www.nflpa.org/pdfs/NewsAndEvents/Timeline_of_NFLPA_Pension_and_
Disability_Improvements.pdf], downloaded Sept. 2007, on file with the author; NFL Players
Association, “History of Retirement and T&P Benefits for NFL Players,” p. 5; and Letter
(continued...)

CRS-23
pension eligibility, increasing [the number of] credited seasons for
159 players,” and “Korean War and Vietnam years were included for
pension credits, adding 182 players.”94 A single plan counsel
(Groom Law Group) and a single plan actuary (Aon Corporation)
were selected. The CBA “based future contributions strictly on
negotiated actuarial factors.”95 The Pete Rozelle Plan and its assets
merged with the Bert Bell Plan, and the NFLPA becomes a certified
union again.96
! 1998. The 1993 CBA was extended through at least 2003. The
extension established an annuity plan; provided for salary guarantees
for certain players; increased minimum salaries, increased the lowest
benefit credit from $80 to $100; increased the T&P disability
benefit; and changed the pension eligibility requirement from five to
four credited seasons.97
! 2002. The CBA was extended again. The extension allowed injured
reserve seasons prior to 1970 to be counted toward pension
eligibility and raised the lowest benefit credits from $100 to $200.98
! 2006. The CB0A was extended and became effective until the last
day of the 2012 league year. The extension raised the lowest benefit
credit from $200 to $250 (for individuals who played during the
period1920-1982); tripled widows’ and surviving children’s
benefits; created the Plan 88 program; and increased the monthly
pension amount by 10% for individuals who played from 1983-
2006.99
! 2007. The following benefits and programs were announced or
established: Health Reimbursement Account Plan, Cardiovascular
93 (...continued)
from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, pp. 4-5.
94 NFL Players Association, “Recent Pensions & Disability Improvements Timeline.”
95 NFL Players Association, “History of Retirement and T&P Benefits for NFL Players,” p.
5.
96 NFL Players Association, “History of Retirement and T&P Benefits for NFL Players,” p.
5.
97 NFL Players Association, “About Us: NFLPA History”; NFL Players Association,
“History of Retirement and T&P Benefits for NFL Players,” p. 6; Letter from Upshaw to
Reps. Conyers, Smith, Sanchez, and Cannon, p. 5; and NFL Players Association, “Recent
Pensions & Disability Improvements Timeline.”
98 Ibid.; NFL Players Association, “History of Retirement and T&P Benefits for NFL
Players,” p. 6.
99 NFL Players Association, “Recent Pensions & Disability Improvements Timeline”; NFL
Players Association, “History of Retirement and T&P Benefits for NFL Players,” p. 6.

CRS-24
Health Program, NFL Player Joint Replacement Benefit Plan, and
assisted living arrangements.100
! 2008. The following changes and programs were announced or
established: expanded health screening that focuses on
cardiovascular health, obesity, and prostate cancer; discounted rates
and special services at three national assisted living providers; and
a prescription drug card that will allow former players to purchase
prescription medications at a discount.101 Additionally, the NFL and
NFLPA announced changes that have been, or will be, made to T&P
and LOD disability benefits. These changes are noted in Table 4.

How Benefits Are Funded
Funds for benefits that are included in the CBA come from the portion of the
league’s total revenues that is allocated to the players. A summary of the definition
of “total revenues” (TR) is as follows:
[T]he aggregate revenues received or to be received on an accrual basis ... by the
NFL and all NFL Teams ... from all sources, whether known or unknown,
derived from, relating to or arising out of the performance of players in NFL
football games, with only the specific exceptions set forth below [in Article
XXIV, Section 1(a)(ii) of the CBA].... Total Revenues shall include, without
limitation: ... gate receipts ... the sale, license or other conveyance of the right to
broadcast or exhibit NFL preseason, regular season and playoff games on radio
and television ... revenues derived from concessions, parking, local advertising,
signage, magazine advertising, local sponsorship agreements, stadium clubs,
luxury box income ... Internet operations... and sales of programs and
novelties....”102
Under the current CBA, the portion of total revenues that goes to players (that is, the
“player costs percentage”103) each year is as follows:
100 Letter from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, p. 5; National
Football League, “NFL & NFL Players Association Create New Joint Replacement Benefit
Plan,” news release, Dec. 10, 2007; and “14 Leading Medical Institutions Selected to Assist
Retired Players Needing Joint Replacement Surgery,” news release, Dec. 10, 2007. Few
details are available about some of these initiatives, which means that eligibility criteria, the
application process (if any), and the extent of benefits are unknown.
101 National Football League and NFL Players Association, “NFL and NFL Players
Association Expand Disability Benefits Program for Retired Players,” Feb. 29, 2008,
available at [http://www.nflplayers.com/user/content.aspx?fmid=178&lmid=443&pid=
422&type=n], p. 3. Detailed information about these initiatives is provided later in this
report.
102 National Football League and NFL Players Association, NFL Collective Bargaining
Agreement, 2006-2012, pp. 82-83.
103 Player costs include “the total Salaries and Benefits attributable to a League Year for all
NFL Teams under all of the rules set forth in Article XXIV (Guaranteed League-wide
Salary, Salary Cap & Minimum Team Salary), but not including loans, loan guarantees,
(continued...)

CRS-25
! 2006: 57%
! 2007: 57%
! 2008: 57.5%
! 2009: 57.5%
! 2010: 58%
! 2011: 58%104
The amount of money equivalent to the player costs percentage in a given year is
allocated between active players’ salaries and benefits for both active players and
retired players. The following description of how a team’s salary cap is determined
shows the relationship between salaries and benefits: in 2008, the amount of a team’s
salary cap will be “57.5% of Projected Total Revenues, less League-wide projected
benefits, divided by the number of Teams playing in the NFL during such year....”105
The following definition of “benefits” lists the different benefits for active players
and former players that are funded in the manner described above:
Benefits “mean the aggregate for a League Year of all sums paid ... by the NFL
and all NFL Teams for, to, or on behalf of present or former NFL players, but
only for: (i) pensions funding, including the Bert Bell/Pete Rozelle NFL Player
Retirement Plan ... and the Second Career Savings Plan ...; (ii) Group insurance
programs, including life, medical, and dental coverage ... and the Second Career
Savings Plan; (iii) Injury protection ...; (iv) Workers’ compensation, payroll,
unemployment compensation, social security taxes, and contributions to the fund
described in Article LIV, Section 4 below [Worker’s Compensation Offset
Provisions]; (v) Pre-season per diem amounts ... and regular season meal
allowances ...; (vi) Expenses for travel, board and lodging for a player
participating in an off-season workout program ...; (vii) Payments or
reimbursements made to players participating in a Club’s Rookie Orientation
Program ...; (viii) Moving and travel expenses ...; (ix) Postseason pay ...; and
salary paid to practice squad players ...; (x) Player medical costs ...; (xi)
Severance pay ...; (xii) The Player Annuity Program ...; (xiii) The Minimum
Salary Benefit ...; (xiv) The Performance Based Pool ...; (xv) The Tuition
Assistance Plan ...; (xvi) The NFL Players Health Reimbursement Account ...;
(xvii) The “88 Benefit” ...; (xviii) The NFL Player Benefits Committee....”106
The portion of the “League-wide projected benefits” needed “to fund the
Retirement Plan is calculated actuarially, in accordance with federal law.”107 The
103 (...continued)
unpaid grievances attributions, and unearned incentives.” (National Football League and
NFL Players Association, NFL Collective Bargaining Agreement, 2006-2012, p. 7.)
104 NFL Players Association, “NFLPA Term Sheet - Basic Economic Terms,” Mar. 7, 2006,
available at [http://www.nflpa.org/pdfs/CBA/2006_CBA_Extension_Term_Sheet.pdf],
downloaded Sept. 2007, on file with the author.
105 National Football League and NFL Players Association, NFL Collective Bargaining
Agreement, 2006-2012, p. 96.
106 Ibid., pp. 93-94.
107 Letter from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, p. 29.

CRS-26
same is also true for the Health Reimbursement Account Plan.108 (The retirement
plan and the Health Reimbursement Account Plan are described below.) According
to the NFL and the NFLPA, the actuarial assumptions, or factors, that are used are
negotiated during the collective bargaining process and are “acceptable to the plan’s
Enrolled Actuary.”109 The following excerpt from the CBA describes the process:
For the 1993 Plan Year and continuing for each Plan Year110 thereafter that
begins prior to the expiration of the Final League Year,111 a contribution will be
made to the Retirement Plan on behalf of each NFL Club as actuarially
determined to be necessary to fund the benefits provided in this Article [of the
CBA], based on the actuarial assumptions and methods contained in Appendix
J [of the CBA]. No provision of this Agreement will eliminate or reduce the
obligation to provide the benefits described in this Article, or eliminate or reduce
the obligations of the NFL Clubs to fund retirement benefits. Contributions will
be used exclusively to provide retirement benefits and to pay expenses.112
Similar language is found in the Bert Bell/Pete Rozelle NFL Player Retirement Plan:
For each Plan Year that begins prior to the expiration of the Final League Year,
a contribution to the Trust [the trust agreement for the Retirement Plan] will be
made by the Employers, as actuarially determined to be necessary to fund the
benefits provided in this Plan based on the actuarial assumptions and methods
contained in Appendix A [of the Retirement Plan].113
Funding for benefits other than the retirement plan and the Health
Reimbursement Account apparently is not calculated using actuarial methods and
assumptions. The NFLPA has stated that “[t]he contribution necessary to fund other
benefit plans is more simply calculated as the total of the benefits provided plus all
costs of administration. For the new 88 Plan, the consultants estimated an initial
108 Ibid.
109 Letter from Goodell to Reps. Conyers and Smith, p. 10; NFL Players Association,
“History of Retirement and T&P Benefits for NFL Players,” p. 5. In 1993, a single plan
counsel, Groom Law Group, and a single plan actuary, Aon Corporation, were selected for
the retirement plan. (NFL Players Association, “History of Retirement and T&P Benefits
for NFL Players,” p. 5.)
110 “‘Plan Year’ means a 12-month period from April 1 to March 31. A Plan Year is
identified by the calendar year in which it begins.” (Bert Bell/Pete Rozelle NFL Player
Retirement Plan, Apr. 1, 2001, p. 6.)
111 Final League Year is “the League Year which is scheduled prior to its commencement
to be the final League Year of the Collective Bargaining Agreement.” A “League Year” is
“the period from February 20 of one year through and including February 19 of the
following year, or such other one year period to which the NFLPA and the [NFL’s]
Management Council may agree.” (Bert Bell/Pete Rozelle NFL Player Retirement Plan, pp.
4 and 6.)
112 National Football League and NFL Players Association, NFL Collective Bargaining
Agreement: 2006-2012, p. 203.
113 Bert Bell/Pete Rozelle NFL Player Retirement Plan, p. 10.

CRS-27
contribution of $1.88 million, all to benefit retired players.”114 The method or
methods used to determine how much money to allocate to this and other benefits is
unknown.
Data provided by the NFL and the NFLPA show that possibly $919.6 million
was spent on benefits for retired players in 2006 and 2007. However, the ways in
which the data are presented by the two organizations leave room for interpretation.
The NFLPA states that “active players gave up approximately” the following
amounts (which total $181.6 million) during the period April 2006 through March
2007 for benefits for former players:115
! $96.5 million for retirement benefits for retired players;
! $31 million for medical benefits for retired players ($18 million for
health reimbursement accounts, $2 million for the 88 Plan, and $11
million for “five years post-retirement fully paid health care”);
! $20 million for disability benefits for retired players; and
! $34.1 million to fund workers’compensation coverage.116
In fall 2007, the NFLPA also noted that 38% of vested former players were receiving
monthly benefits at that time.117
According to the NFL, “... clubs contributed approximately $388 million” in
2006 to fund the Supplemental Disability Plan, Second Career Savings Plan, Annuity
Program, Group Insurance Plan, Health Reimbursement Account Plan, 88 Plan,
Severance Plan, and Tuition Reimbursement (which is not included in this report).118
The NFL estimated that the costs of these benefits in 2007 would be $350 million.
Although the NFLPA regularly describes the amount of funds provided for
retirees’ benefits in terms of how the “[b]enefit costs reduce the revenue available for
active players under the” CBA, it appears that this description refers to the process
described above for the allocation of funds for benefits.119 Regarding the NFL’s
statement that the teams contribute funds for benefits, it seems plausible that this
statement, too, refers to the allocation process described above.
The differences in the information provided by the NFL and NFLPA make it
difficult to determine exactly how much money was spent for each benefit in 2006
114 Letter from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, p. 29.
115 The NFLPA describes the amount of funds provided for retirees’ benefits in terms of how
the “[b]enefit costs reduce the revenue available for active players under the” CBA. (NFL
Players Association, “NFLPA White Paper” n.d., available at [http://www.nflpa.org/
whitepaper/], downloaded Sept. 2007, on file with the author, p. 4.) This description
appears to refer to the allocation process described above in this report.
116 Letter from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, pp. 29-30.
117 Ibid., p. 9.
118 The NFL will have contributed a total of $2.2 billion for these benefits during the period
1998-2007. (Letter from Goodell to Reps. Conyers and Smith, p. 12.)
119 NFL Players Association, “NFLPA White Paper,” p. 4.

CRS-28
or 2007. The NFLPA provided information that covers both years, while the NFL
provided an amount for each year. Additionally, the NFLPA provided a breakdown
by type of benefit (that is, retirement benefits, medical benefits, and disability funds)
and amount, while the NFL provided an aggregate amount for eight different
benefits, each of which is listed by the name of the benefit.
Benefits for Former Players
Table 4 provides a summary of the benefits available to former players;
eligibility requirements vary by benefit. This overview includes selected features for
each type of benefit. For detailed information about a particular benefit, it is best to
consult the appropriate document, such as the CBA. Workers’ compensation is
included because, although states administer workers’ compensation programs, the
NFLPA and the NFL provide funding for workers’ compensation for their players.
The following is a list of the benefits included in Table 4. Shortened names are
used in the table because this format makes it easier to identify the description or
purpose of the benefit. Each benefit is identified by its complete name, as well as a
shortened version. For example, the NFL Players Health Reimbursement Account
appears as “Health Reimbursement Account” in the table. An asterisk identifies a
benefit that is included in the CBA.
! 88 Benefit (or Plan)*
! Cardiovascular Health (CVH) Program
! Bert Bell/Pete Rozelle NFL Player Retirement Plan — Death
Benefits (“death benefits”)*
! Bert Bell/Pete Rozelle NFL Player Retirement Plan — Line-of-Duty
Disability (“line-of-duty disability”or “LOD disability”)*
! Bert Bell/Pete Rozelle NFL Player Retirement Plan — Retirement
Benefits (“retirement benefits” or “pension”)*
! Bert Bell/Pete Rozelle NFL Player Retirement Plan — Total and
Permanent Disability Benefits (“total and permanent disability
benefits” or “T&P benefits”)*
! NFL Player Annuity Program (“annuity program”)*
! NFL Player Joint Replacement Benefit Plan (“joint replacement
benefit plan”)
! NFL Player Second Career Savings Plan (“second career savings
plan”)*
! NFL Player Supplemental Disability Plan (“supplemental disability
plan” or “supplemental disability benefits”)*

CRS-29
! NFL Players Health Reimbursement Account (“health
reimbursement account”)*
! Retiree Medical* (This benefit is part of Group Insurance, which is
how the benefit is listed in the CBA. The remainder of the Group
Insurance benefit is available to only active players.)
! Severance Pay*
! Workers’ Compensation

CRS-30
Table 4. Selected NFL-NFLPA Benefits as of October 2007
Name of Benefit or
Players from
Summary of Eligibility
Program and Year
These Years May
Selected Featuresb,c
Criteriaa
Established
Participate
88 Pland,e
All years
Vested player who is suffering
— Plan will reimburse, or pay for, certain costs related to dementia.
February 1, 2007
from dementia.
— A maximum of $88,000 may be paid annually for expenses for care
provided by a third party (for example, institutional custodial care or
home custodial care provided by an unrelated third party). The
maximum amount of this benefit is $50,000 annually for care that is not
provided by a third party (for example, a relative provides care at
home).
Annuity Programd
1998-present
Minimum of four credited
— This is a deferred compensation program.
April 1, 1998
seasons.
— An allocation of $65,000 will be made for each eligible player who
earns a credited season in an annuity year and who has a total of four or
more credited seasons as of the end of such annuity year.
Cardiovascular Health
All years
Apparently, this program is
— Provides cardiovascular screening and education.
(CVH) Program
open to all players.
July 25, 2007
Death Benefitsd
All years
Vested inactive or active
— Provides financial assistance to widow and/or surviving minor
September 19, 1962
player.
children of a former or active player.
— Monthly benefit equal to $3,600 or 50% of the player’s benefits,
whichever is greater. For first 48 months after player’s death, the
amount of the benefit cannot be less than $6,000/month for a player
who was an active player after 1976 plan year, or $9,000/month for a

CRS-31
Name of Benefit or
Players from
Summary of Eligibility
Program and Year
These Years May
Selected Featuresb,c
Criteriaa
Established
Participate
player who was an active player after the 1981 plan year.
— For a widow, benefit ends with her death or remarriage. For
children, benefit ends upon reaching the age of 19 (or 23, if in college).
Termination based on age does not apply if child is mentally or
physically incapacitated.
Health Reimbursement
2004-present
At least eight credited seasons
— An annual contribution is made to a player’s account in the amount
Account (HRA)d
for a player whose last credited
of $25,000 or $50,000, depending upon the terms of the CBA. Total
March 1, 2007
season was 2004 or 2005. At
contributions shall not exceed $300,000.
least three credited seasons for
— Player may receive reimbursement for medical care expenses only
a player who earned a credited
during periods of time when he is not covered by the Group Insurance
season in 2006 or any later
in the CBA or the Extended Post-Career Medical and Dental Insurance
year.
in the CBA.
Joint Replacement Benefit
All years
Unknown.
— Assists retired players who need joint replacement surgery.
Plan
— Plan provides financial assistance to all eligible former players to
2007f
cover the cost of surgery.
— Additional financial assistance is available from the NFL Player
Care Foundation.
Line of duty (LOD)
All years
Any player who incurs a
— Amount of monthly benefit will equal the sum of the player’s
disability benefitd
substantial disablement (but is
benefit credits (see Retirement Benefits) or $1,000, whichever is
April 1, 1970
not totally and permanently
greater.
disabled) arising out of NFL
— Payments continue for duration of substantial disablement, but no
football activities, as
longer than 7 ½ years.

CRS-32
Name of Benefit or
Players from
Summary of Eligibility
Program and Year
These Years May
Selected Featuresb,c
Criteriaa
Established
Participate
determined by the Retirement
— If both an LOD benefit and a T&P benefit are payable, only the
Board or the Disability Initial
larger of the two benefits will be paid.
Claims Committee (DICC),
— Application for LOD benefit must be submitted within 48 months
that is a significant factor in
after player ceases to be an active player.g
causing his retirement from
football. Player does not have
to be vested.
Retiree Medicald,h
1993-present
Vested.
— Active players receive group insurance benefits: life insurance, and
May 6, 1993
medical and dental benefits. The same medical and dental benefits are
provided to former players for a set amount of time, as described below.
— Players released or who otherwise severed employment after the
first regular season game in the 2002 season, but before the first regular
season game in 2005 season, continue to receive medical and dental
benefits for 48 months.
— Players released after the first regular season game in the 2005
season and prior to the expiration or termination of the 2006-2012 CBA
will receive medical and dental benefits for the following 60-month
period.
Retirement Benefitsd,i
All years
Vested player.
— A player earns a benefit credit for each credited season, and a
September 19, 1962
vested player’s monthly pension is the sum of his benefit credits for
each of his credited seasons. Under the 2006-2012 CBA, the benefit
credits are as follow:j

CRS-33
Name of Benefit or
Players from
Summary of Eligibility
Program and Year
These Years May
Selected Featuresb,c
Criteriaa
Established
Participate
Credited Season ----------- Benefit Credit
Before 1982 ---------------- $250
1982-1992 ------------------ $255
1993-1994 ------------------ $265
1995-1996 ------------------ $315
1997 ------------------------- $365
1998-presentk --------------- $470

— Any vested inactive player may choose to receive his benefits at the
normal retirement age, which is 55 under the retirement plan, or later
(that is, deferred retirement). A vested inactive player with at least one
credited season prior to 1993 plan year may elect for early retirement
(which begins at age 45). Benefits will be adjusted accordingly for a
player who chooses deferred retirement or early retirement. Benefits
will be increased for deferred retirement, and decreased for early
retirement.
— A vested player who leaves the NFL on or after March 1, 1977, has
at least one credited season prior to the 1993 plan year, and is no longer
an employee may elect to receive an early payment benefit in the form
of a lump sum, a life-only pension, or a qualified joint and survivor
annuity. If a player receives an early payment benefit, his monthly
pension will be based upon 75% of the sum of his benefit credits.
— A player who chooses an early payment benefit after March 31,

CRS-34
Name of Benefit or
Players from
Summary of Eligibility
Program and Year
These Years May
Selected Featuresb,c
Criteriaa
Established
Participate
1982, will have any subsequent payments for certain benefits (for
example, total and permanent disability benefits, line-of-duty disability
benefits) reduced by 25%.
Second Career Savings
1993-present
A first-year player may
— Matching contributions shall be two dollars for each dollar provided
Pland
contribute to the plan. A player
by a player. The maximum matching contributions, which vary by plan
July 1, 1993
must have at least two credited
year under the CBA, are as follow: $20,000 for each year, 2006-2008;
seasons, at least one of which
$22,000 for 2009; $24,000 for 2010, and $26,000 for 2011.
is for Plan Year 2006 or later,
— Beginning at age 45, a player may withdraw money from his
in order to receive a club
account.
contribution.
Severance Payd
1982-present
Minimum of two credited
— A player’s severance pay will equal the sum of the following:
November 16, 1982
seasons. At least one of the
$5,000 per credited season for each season during the period1989-1992;
seasons must have occurred
$10,000 per credited season for each season during the period 1993-
during the period 1993-2011.
1999; $12,500 per credited season for each season during the period
Player’s written request for
2000-2008; and $15,000 per credited season for each season during the
severance pay must indicate
period 2009-2011.
that he intends to permanently
— Severance pay is paid in a single lump sum. Payment date varies
sever employment as an active
depending upon when the individual was last involved in a league
player.
playing activity and when he submits an application.
Supplemental Disability
1993-present
Former players who receive
— Supplemental disability plan benefits are automatically paid to each
Pland,l
T&P disability benefits in the
eligible player.
July 1, 1993
“active football,” “active
— Effective April 1, 2000, the monthly and annual supplemental

CRS-35
Name of Benefit or
Players from
Summary of Eligibility
Program and Year
These Years May
Selected Featuresb,c
Criteriaa
Established
Participate
nonfootball,” and “football
disability plan benefit for each category is as follows: “active football,”
degenerative” categories.
$14,670 monthly and $176,040 annually; “active nonfootball,” $7,167
monthly and $86,004 annually; and “football degenerative,” $5,167
monthly and $62,004 annually.m
— Players who receive T&P “inactive” category benefits do not
receive any benefits under this plan.m
Total and Permanent
All years, except for
Active player (he does not have
— The amount of a player’s benefit will be equal to the sum of his
Disability Benefitd,h,n
an inactive player
to be vested) or vested inactive
benefit credits, excluding benefit credits for credited seasons prior to
April 1, 1970
who does not have a
player who is totally and
1958. The benefit amount may be increased as follows for each benefit
credited season after
permanently disabled, as
category:
1958.
determined by the Retirement
(a) Active football: monthly benefit will be not be less than $4,000 if
Board or the DICC.
the disability or disabilities arise out of NFL football activities, arise
while the player is an active player, and cause the player to be totally
and permanently disabled “shortly after” the disability or disabilities
first arise.o
(b) Active nonfootball: monthly benefit will not be less than $4,000 if
the disability or disabilities do not result from NFL football activities,
but do arise while the player is an active player, and cause the player to
be totally and permanently disabled “shortly after” the disabilities first
arise.o
(c) Football degenerative: monthly benefit will not be less than $4,000
if the disability or disabilities arise out of NFL football activities and
result in T&P disability before 15 years after the end of the player’s last
credited season.

CRS-36
Name of Benefit or
Players from
Summary of Eligibility
Program and Year
These Years May
Selected Featuresb,c
Criteriaa
Established
Participate
(d) Inactive: The monthly benefit will not be less than $1,500 ($1,750
for applications received on or after April 1, 2007)p if the T&P
disability or disabilities arise from other than NFL football activities
while the player is a vested inactive player, or the disability or
disabilities arise out of NFL football activities and result in total and
permanent disability 15 or more years after the end of the player’s last
credited season, whichever is later.
(e) Dependent child: monthly benefit will increase $100 per each child
who is a dependent.q
— Effective for payments made on and after November 1, 1998, a
player may receive a T&P payment for a disability resulting from a
psychological/psychiatric disorder. This provision applies only to the
“active nonfootball” and “inactive” categories, and special rules that
pertain to disabilities resulting from other than a football injury.
— A T&P disability that is a result of a psychological/psychiatric
disorder may be awarded under the provisions for “active football” and
“football degenerative”disabilities (and under special rules that pertain
to disabilities resulting from a football injury incurred while an active
player) if the requirements for such a disability are met and the disorder
“(1) is caused by or relates to a head injury (or injuries) sustained by a
Player arising out of League football activities (e.g., repetitive
concussions); (2) is caused by or relates to the use of a substance
prescribed by a licensed physician for an injury (or injuries) or illness
sustained by a Player arising out of League football activities; or (3) is

CRS-37
Name of Benefit or
Players from
Summary of Eligibility
Program and Year
These Years May
Selected Featuresb,c
Criteriaa
Established
Participate
caused by an injury (or injuries) or illness that qualified the Player for
total and permanent disability benefits under Section 5.1(a) [active
football].”r
— T&P benefit is payable for life or until cessation of total and
permanent disability.
Workers’ Compensations
All years
Apparently, all players are
— NFLPA has made arrangements for all players to be covered by
eligible. However, workers’
workers’ compensation, which is available to employees who have been
compensation is regulated and
injured or disabled on the job.
administered by state
— Workers’ compensation may include disability pay or wage loss
governments, which also
benefits, a lump sum benefit to compensate for permanent loss of
means that eligibility
function, and/or payment or reimbursement for medical expenses.
requirements and other details
vary from state to state.
Sources: National Football League and NFL Players Association, NFL Collective Bargaining Agreement: 2006-2012, Mar. 8, 2006; NFL Players Association, “ Line of Duty Disability,”
Mar. 12, 2008, available at [http://www.nflplayers.com/user/content.aspx?fmid=178&lmid=443&pid=367&type=n]; NFL Players Association, “NFLPA and NFL Announced New
Retirement Benefit Initiatives,” news release, July 25, 2007; Bert Bell/Pete Rozelle NFL Player Retirement Plan, Apr. 1, 2001; NFL Player Supplemental Disability Plan, Apr. 1, 2001;
Letter from Eugene Upshaw, Executive Director, NFL Players Association, to Reps. John Conyers, Jr., Lamar S. Smith, Linda T. Sanchez, and Christopher B. Cannon, Nov. 5, 2007,
p. 1; NFL Players Association, “CBA: Workers’ Compensation Benefits,” available at [http://www.nflpa.org/CBA/Workers_Comp.aspx] as of Nov. 15, 2007, on file with the author;
National Football League, “NFL & NFL Players Association Create New Joint Replacement Benefit Plan”; and National Football League “14 Leading Medical Institutions Selected
to Assist Retired Players Needing Joint Replacement Surgery,” news release, Dec. 10, 2007; and Gregory P. Guyton, “A Brief History of Workers’ Compensation,” Iowa Orthopaedic
Journal, 1999, available at [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1888620].

CRS-38
Note: See the glossary in Appendix A for the definition of terms, such as “credited season,” “plan year,” and “vested player.”
a. Since this is only a summary, additional criteria or conditions may apply.
b. The actual amount that a particular individual receives is determined by a number of factors, including, for example, the years in which he played and whether the amount of a
particular benefit is altered by a succeeding CBA. Also, the receipt of a certain benefit may affect the amount of another benefit an individual receives. For example, receipt
of an 88 Plan benefit may result in a decrease in Total and Permanent disability benefits as follows: “The maximum benefit payable for any month shall be reduced, but not below
zero, by the amount of any total and permanent disability benefits paid by the Bert Bell/Pete Rozelle NFL Player Retirement Plan and the NFL Player Supplemental Disability
Plan. However, the maximum benefit payable for any month shall not be reduced by those total and permanent disability benefits paid to players who are receiving the Inactive
total and permanent disability benefit described in Section 5.1(d) of the Bert Bell/Pete Rozelle NFL Player Retirement Plan.” (National Football League and NFL Players
Association, NFL Collective Bargaining Agreement: 2006-2012, Mar. 8, 2006, pp. 215-216.)
c. The amount, eligibility criteria, and other details of a particular Retirement Plan benefit may change over the years as new CBAs are negotiated and the Retirement Plan is changed
accordingly. The details of other (non-retirement plan) benefits may be changed, too, by the NFL and the NFL Players Association.
d. This benefit plan or program is included in the CBA.
e. The 88 Plan was so named to honor John Mackey, a former Baltimore Colts tight end and member of the Hall of Fame who wore number 88. (NFL Players Association, “NFLPA
White Paper,” n.d., available at [http://www.nflpa.org/whitepaper/], p.23.), downloaded Sept. 2007, on file with the author.
f. The NFL announced in Dec. 2007 the establishment of the Joint Replacement Benefit Plan, but it appears that implementation will occur at some later date.
g. As announced on Feb. 29, 2008, the NFL and the NFLPA modified the deadline for applying for LOD benefits. A player will have 48 months or the number of credited seasons
he has earned within which to apply. For example, a player who has six credited seasons will have six years, instead of four years, within which he must apply. The deadline
will equal the number of credited seasons a player has, which means, for example, that a player with six credited seasons will have six years
h. Retiree Medical is part of the Group Insurance benefit in the CBA, where it is identified as “Extended Post-Career Medical and Dental Benefits.” It is unclear whether Retiree Medical
covers injuries sustained as a player. The remainder of the Group Insurance benefit is available to only active players. (National Football League and NFL Players Association,
NFL Collective Bargaining Agreement, 2006-2012, pp. 218-219.)
i. A former player who is receiving T&P disability benefits when he reaches the normal retirement age of 55 will have his disability benefits converted to a retirement benefit (pension).
The amount of the benefit will not change. (Bert Bell/Pete Rozelle NFL Player Retirement Plan, Summary Plan Description, Apr. 2005, p. 18.)
j. For example, “[a]n Active Player for three or more games of the 1996 through 1999 seasons [would receive] Benefits Credits [in the amount of] $1,465 ($285 + $330 + $425 +$425
= $1,465). The player will, therefore, receive $1,465 per month when he begins to receive his pension benefit at age 55.” (NFL Players Association, “Rules and Regulations:
Player Benefits,” n.d., available at [http://www.nflpa.org/RulesAndRegs/PlayerBenefits.aspx] as of Aug. 21, 2007, on file with the author.)
k. Specifically, the benefit credit of $425 is for each credited season from 1998 “through the Plan Year that begins prior to the expiration of the Final League Year.” (Bert Bell/Pete
Rozelle NFL Player Retirement Plan, p. 11.)
l. Per the NFLPA, the Supplemental Disability Plan was created because, pursuant to federal statute(s), there is a cap on the amount of disability benefits a plan may pay, such as the
retirement plan for former players. (Letter from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, p. 19.)
m. See “Total and Permanent Disability Benefit” in the table for information about the four categories of T&P benefits.

CRS-39
n. In Feb. 2008, the NFL and the NFLPA announced the following changes to the T&P disability benefit: “Players who took their NFL pension early, and are therefore ineligible to
apply for and receive disability benefits, will be offered a new one-time opportunity to apply for total and permanent disability benefits. These players may establish their disability
through either a medical examination or by a total and permanent disability determination from Social Security. The opportunity to apply for benefits will begin on April 1, 2008.
Applications will be accepted through July 31, 2008. Players who have received a total and permanent disability determination from Social Security will not need to separately
establish disability under the NFL plan. Players who were denied benefits under the NFL plan but have subsequently been found [to be] disabled by [the] Social Security
[Administration] may have their NFL cases reconsidered. The other good news for retired NFL players is that NFL disability awards are not offset by the amount of any award
paid by Social Security.” (National Football League and NFL Players Association, “NFL and NFL Players Association Expand Disability Benefits Program for Retired Players,”
Feb. 29, 2008, available at [http://www.nflplayers.com/user/content.aspx?fmid=178&lmid=443&pid=422& type=n], p. 1.)
o. “A Player who becomes totally and permanently disabled no later than six months after a disability(ies) first arises will be conclusively deemed to have become totally and
permanently disabled ‘shortly after’ the disability(ies) first arises, as that phrase is used in subsections (a) and (b) above [descriptions of benefits for players who experience active
football and active nonfootball disabilities], and Player who becomes totally and permanently disabled more than 12 months after a disability(ies) first arises will be conclusively
deemed not to have become totally and permanently disabled ‘shortly after’ the disability(ies) first arises as that phrase is used in subsections (a) and (b) above. In cases falling
within this six-to twelve-month period, the Retirement Board or the Disability Initial Claims Committee will have the right and duty to determine whether the ‘shortly after’
standard is satisfied.” (Bert Bell/Pete Rozelle NFL Player Retirement Plan, p. 20.)
p. The NFL and the NFLPA announced on Feb. 29, 2008, that “the minimum benefit post-career” for “non-football ‘total and permanent’ disability” had doubled from “$20,000 to
$40,000 per year for retired players who become disabled unrelated to football.” (National Football League and NFL Players Association, “NFL and NFL Players Association
Expand Disability Benefits Program for Retired Players,” p. 1.)
q. A child is considered to be a dependent only until reaching the age of 19; if he or she is in college, age 23 is the threshold. (Bert Bell/Pete Rozelle NFL Player Retirement Plan, p.
4.)
r. Bert Bell/Pete Rozelle NFL Player Retirement Plan, p. 21.
s. The year that this benefit was established is unknown.

CRS-40
NFLPA Retired Players Department
The Retired Players Department, established in 1984,
acts to meet players’ needs with the right services; continuously communicates
and involves players of all ages to create an exclusive fraternity; works
collaboratively with other NFLPA departments and Players Inc.120 to give
outstanding value to its members; provides leadership, administration,
coordination and implementation to serve the needs of retired players and retired
player chapters.121
The department’s objectives are
! “To establish more local chapters [of retired players]”;
! “To increase the future pensions and benefits for all players”;
! “To establish a formal line of communication between active and
retired players”;
! “To build a network of retired players for business contacts and
second careers”;
! “To help build the image of the game and promote it to the benefit
of players; and”
! “To raise funds for the Players Assistance Trust (PAT).”122
Accomplishments of the Retired Players Department include
! “[Assisting players] in gaining pension and disability benefit
increases”;
120 “In September 2000, NFL PLAYERS and the NFL entered into a historic partnership to
provide player group licensing rights to NFL sponsors. With this deal, NFL sponsors are
given the right to utilize players as part of their sponsorship agreements.... Activities
include marketing, licensing, special events, corporate sponsorship, media and content
development, publishing, website (NFLPLAYERS.COM) and other promotional programs.
PLAYERS INC is a fully integrated marketing company for active and retired NFL players.
These activities generate guaranteed royalties to PLAYERS INC and the players, in addition
to providing financial support to the NFLPA. The organization is committed to meeting the
needs of all NFL players in the National Football League by creating player marketing
opportunities, increasing brand awareness and developing valuable business partnerships.”
(NFL Players Association, “Sponsors/Licensees,” available at [http://www.nflplayers.com/
user/template.aspx?fmid=182&lmid=243&pid=0&type=l].) (Capitalization is in the
original.)
121 NFL Players Association, “Retired Players Department: FAQs,” n.d., available at
[http://www.nflpa.org/Faqs/Faqs.aspx?printer_friendly=yes] as of Nov. 2, 2007, on file with
the author, p. 1.
122 Letter from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, p. 27.

CRS-41
! “[Administering] the PAT Fund, resulting in over $5 million in
payments on behalf of former players in need”;
! “[Assisting] in networking between former players and potential
employers”;
! “Helping former players take advantage of workers compensation
benefits under state law; and”
! “Providing the services of medical professionals in various areas
including orthopedic and cardiovascular.”123
Any player who had signed a contract with a team is eligible to join a chapter,
and there are 33 chapters of former players across the country.124 Chapter presidents
attend the annual chapter officers meeting and the Retired Players Convention. An
election is held at the latter for the Retired Players Steering Committee, which is “the
only elected national body representing retired players....”125
Players Assistance Trust (PAT) Fund
The players association created the Professional Athletes Foundation (PAF), a
501(c)(3) organization under the Internal Revenue Code, in 1987.126 The
foundation’s mission is to “provide vocational, educational, recreational and athletic
opportunities for people of all races, religions and nationalities, male and female,
wherever they may live, including but not limited to needy, former, amateur and
professional athletes and young people who might not have the fullest opportunity
to develop their vocational and educational capabilities.”127
In 1992, the foundation established the Player Assistance Trust (PAT) to
“provide financial assistance to former professional and amateur players and their
families....”128 Specifically, the PAT is to provide
short-term financial assistance to former players who find themselves in a
financial crisis. A primary goal of the fund is to assist players who are faced
with financial problems created by catastrophic illness.... The funds cannot be
used for long-term financial support. Grants are not available for supplemental
123 Ibid.
124 Ibid., p. 26.
125 NFL Players Association, “Retired Players Department: FAQs,” p. 1.
126 This organization is a tax-exempt organization under the Internal Revenue Code. For
more information, see U.S. Dept. of the Treasury, Internal Revenue Service, “Exemption
Requirements,” available at [http://www.irs.gov/charities/charitable/article/0,,id=
96099,00.html].
127 NFL Players Association, “Retired Players Department: FAQs,” pp. 4-5.
128 Ibid., p. 5.

CRS-42
income to pension benefits. Grants are not available as loans for business
transactions.129
The maximum grant amounts available are $10,000 for educational purposes and
$20,000 for financial or medical assistance; not every applicant, however, receives
the maximum amount.130
Donations from the players association, the NFL, and individuals, and a
percentage of the fines levied against active players provide funding for the PAT.
Since 2000 and through fall 2007, the amount of money from fines contributed to
the PAT was $2,814,692.131 The NFL has contributed the following amounts, which
total $6,350,000:
! 1997: $350,000
! 1998: $350,000
! 1999: $350,000
! 2000: $700,000
! 2001: $700,000
! 2002: $700,000
! 2003: $700,000
! 2004: $1,000,000
! 2005: $1,250,000
! 2006: $1,250,000132
Data about grants awarded during the period 1991-2007 are provided in the
following two tables. Table 5 shows how many grants were awarded, by type (for
example, education, financial, and medical). Table 6 shows how many grants were
awarded each year. A total of 860 grants have been awarded since the inception of
the PAT, and, according to other information provided by the NFLPA, grants have
been awarded to 662 different players and widows of players.133
129 NFL Players Association, “Players Assistance Trust Fund Grant Guidelines,” n.d.,
available at [http://www.nflpa.org/pdfs/Charitywork/PAT_Application_2007.pdf],
downloaded Sept. 2007, on file with the author, p. 1.
130 Ibid., p. 2.
131 Letter from Goodell to Reps. Conyers and Smith, p. 12.
132 Ibid.
133 Letter from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, p. 28.

CRS-43
Table 5. Players Assistance Trust Fund Grants,
by Grant Type, 1991-2007
Number and Percentage
Amount and Percentage
Type of Grant
of Grantsa
of Moneya
Education
92
$398,393.22
11%
7%
Education/Financial
11
$72,597.66
1%
1%
Financial
585
$3,861,965.46
68%
70%
Medical
119
$698,313.49
14%
13%
Medical/Financial
52
$473,941.67
6%
9%
Unknown
1
$3,315.00
<1%
<1%
Total
860
$5,508,526.50
Source: Data provided by the NFL Players Association; calculations performed by the author.
Note: The data for 2007 may be incomplete as the data were provided before the end of 2007.
a. Percentages have been rounded.
Significant percentages of the number of PAT grants (88%) and the amount of
money (92%) have been awarded for financial or medical purposes, or for a
combination of the two. Only 12% of the grants, and 8% of the money, were
awarded for education and education/financial purposes. The largest average grant,
$6,855.29, was for medical and medical/financial purposes. The average amount of
a financial grant was $6,601.65. The average amount of an education and
education/financial grant was $4,572.73. Overall, the average amount of a grant was
$6,405.26.
Table 6. Players Assistance Trust Fund Grants,
by Year, 1991-2007
Number and
Amount and
Average Amount
Year
Percentage of
Percentage of
of Grantb
Grantsa
Grantsa,b
1991
2
$4,836
$2,418
<1%
<1%
1992
19
$92,120
$4,848
2%
2%

CRS-44
Number and
Amount and
Average Amount
Year
Percentage of
Percentage of
of Grantb
Grantsa
Grantsa,b
1993
33
$134,937
$4,089
4%
2%
1994
25
$122,609
$4,904
3%
2%
1995
37
$190,019
$5,136
4%
3%
1996
48
$354,419
$7,384
6%
6%
1997
51
$341,975
$6,705
6%
6%
1998
46
$275,267
$5,984
5%
5%
1999
46
$387,044
$8,414
5%
7%
2000
17
$91,668
$5,392
2%
2%
2001
35
$210,493
$6,014
4%
4%
2002
32
$205,505
$6,422
4%
4%
2003
45
$281,239
$6,250
5%
5%
2004
56
$360,824
$6,443
7%
7%
2005
130
$867,392
$6,672
15%
16%
2006
143
$834,881
$5,839
17%
15%
2007c
95
$753,300
$7,929
11%
14%
Total
860
$5,508,528
$6,405
Source: Letter from Eugene Upshaw, Executive Director, NFL Players Association, to Reps. John
Conyers, Jr., Lamar S. Smith, Linda T. Sanchez, and Christopher B. Cannon, Nov. 5, 2007, exhibit
C; calculations performed by the author.
a. Percentages have been rounded.
b. Dollar amounts have been rounded to the nearest dollar.
c. The data for 2007 may be incomplete as the data were provided before the end of 2007.

CRS-45
Despite the possibility that the data for 2007 may be incomplete (for the reason
stated above), over 40% of the grants were awarded during the years 2005-2007; 368
grants, 43% of the total, were awarded during this period. Accordingly, the
percentage of grants awarded in each of these years is in double digits. For the
previous 14 years, the percentage of grants awarded each year ranged from less than
1% to 7%. Consistent with these results, 45% ($2,455,573) of the total amount of
the grants was awarded during the period 2005-2007. The reasons for the relatively
consistent percentage of grants for each year from 1991 through 2004, and the
noticeable increase in 2005 followed by similarly high percentages in 2006 and 2007
are unknown. More former players needed assistance during these three years, but
it is unclear whether the rise in the number of grants is related to, for example, the
type and amount of benefits the players received from NFL/NFLPA-funded benefits
and whether these benefits met their needs; wider dissemination of information about
the PAT (if indeed information was disseminated more widely than had been done
previously); or changes, if any, that were made to the PAT applications process.
Regarding the average amount of a grant, there has been a general upward trend.
Aside from the initial year, when only two grants were awarded and the average grant
amount was $2,418, the average amount has increased from $4,848 in 1992 to $7,929
in 2007. However, the highest average amount, $8,414, was in 1999, and the average
amount in 2006 was $5,839.
The NFL has noted that individual clubs also fund efforts involving former
players; usually, these efforts are directed toward players who were members of a
particular club.134
The Alliance
In May 2007, four organizations — the NFL, the NFLPA, the NFL Alumni
Association, and the Pro Football Hall of Fame — came together to form the
“Alliance,” which “is aimed at addressing the medical concerns and needs of retired
players, including joint replacements, cardiovascular health programs and assisted
living arrangements.”135 In December 2007, the NFL announced the establishment
of the NFL Player Care Foundation, which is “governed by representatives of
members of the Alliance,” and which apparently will administer the $17 million that
has been donated to date.136 In February 2008, the NFL and the NFLPA announced
that four former players — Andre Collins, Willie Lanier, Randy Minniear, and Ozzie
Newsome — had been appointed to the board of the directors for the NFL Player
Care Foundation, and that these board members would select additional members.137
134 Letter from Goodell to Reps. Conyers and Smith, p. 12.
135 Ibid.; National Football League, “NFL Clubs Commit $10 Million in Additional Funding
to Retired Players for Medical Assistance.”
136 National Football League, “NFL & NFL Players Association Create New Joint
Replacement Benefit Plan.”
137 National Football League and NFL Players Association, “NFL and NFL Players
Association Expand Disability Benefits Program for Retired Players,” p. 3.

CRS-46
The foundation will coordinate and provide funds to the programs established by the
Alliance.138
When the league and the players association announced, in July 2007, the
formation of this group, they also announced that the Alliance had received $7
million.139 NFL team owners approved a donation of an additional $10 million in
October 2007.140 Fines paid by active players to the NFL for on-field infractions, and
contributions from the NFLPA, other members of the Alliance, and “other interested
retired player groups” will supplement the $17 million.141
As part of this initiative, the NFL and the players association created the NFL
Player Joint Replacement Plan in fall 2007. Fourteen medical centers have been
selected to provide these services:
[The medical centers will] assist eligible retired players in need of joint
replacement surgery.... The medical facilities, carefully chosen for their
expertise, high-quality service and reputation, will make available specialized,
coordinated care to players covered by this new program. The program provides
a common application process to assist them gain access to the institutions. The
plan also will provide financial assistance to all players, regardless of their
financial situation, to cover the cost of the operations. For players not covered
by insurance and who cannot pay for the procedure, additional financial
assistance will be available from the newly created NFL Player Care Foundation.
Players eligible for assistance from the NFL Player Care Foundation will not be
responsible for the cost of either the joint replacement surgery or post-operative
rehabilitation.142
As reported in The New York Times, only retired players who are vested are eligible
for this benefit.143
The following 14 institutions will provide joint replacement surgery: St.
Vincent’s Birmingham/Andrews Sports Medicine & Orthopaedic Center
(Birmingham, AL), Broward General Medical Center (Ft. Lauderdale, FL), Centinela
Freeman Regional Medical Center (Marina del Rey, CA), Cleveland Clinic
Foundation (Cleveland, OH), Lenox Hill Hospital (New York, NY), MedStar Health
— Georgetown University Hospital and Union Memorial Hospital (Washington,
138 Information provided electronically by the NFL Players Association to the author on Mar.
3, 2008.
139 NFL Players Association, “NFLPA and NFL Announce New Retirement Benefit
Initiatives.”
140 National Football League, “NFL Approves Additional $10 Million for Retired Players,”
news release, Oct. 24, 2007, available at [http://search.nfl.com/search/?query=recent&sort=
date&page=5].
141 National Football League, “NFL Approves Additional $10 Million for Retired Players.”
142 National Football League, “NFL & NFL Players Association Create New Joint
Replacement Benefit Plan,” news release, Dec. 10, 2007.
143 Frank Listky, “Rehab Plan Announced for N.F.L.’s Ex-Players,” New York Times, Dec.
11, 2007, available at [http://www.nytimes.com/2007/12/11/sports/football/11joints.html].

CRS-47
DC, and Baltimore, MD, respectively), Methodist Hospital, (Houston, TX), Mount
Sinai Medical Center (New York, NY), Northwestern Memorial Hospital (Chicago,
IL), OASIS MSO, Inc. (San Diego, CA), St. Joseph’s Hospital-Atlanta (Atlanta, GA),
Texas Orthopedic Hospital (Houston, TX), and University of Pittsburgh Medical
Center (Pittsburgh, PA).144 Houston, New York, the Washington, DC, metropolitan
area, and the state of California have two facilities each that are on the list. The
remaining six institutions are in Alabama, Florida, Georgia, Ohio, Illinois, and
Pennsylvania. Without information about the location of former players, it is
unknown how many retired players reside in or near these 10 cities or metropolitan
areas.
Post-surgery rehabilitation and physical therapy will be provided to eligible
former players by HCR Manor Care, which has 280 skilled nursing and rehabilitation
centers and 85 outpatient rehabilitation therapy clinics across the country.145
The Alliance has also developed the following programs:
Health screening — Two doctors, funded by the NFL Player Care Foundation,
are working with medical centers throughout the country to make it easier for
players to get cardiovascular screening without cost. Players found to need
cardiovascular care will receive affordable medical, nutritional and other
treatment. Obesity screening and education also is provided.
Prostate cancer screening — In conjunction with the American Urological
Association, the Alliance will establish a comprehensive program of prostate
cancer screening, care and education.
Assisted living arrangements — Negotiated discounted rates and special
services are made available to former players at three leading national assisted
living providers — Brookdale Senior Living, Inc.; Belmont Village L.P., and
Silverado Senior Living, Inc.
Prescription drug card — The NFL and NFLPA are providing retired players
with a prescription drug card that permits them to purchase prescription
medications at a substantial discount. This new benefit is provided at no cost to
former players.146
144 Ibid.
1 4 5 Ibid. Information about HCR Manor Care is available at
[http://www.hcr-manorcare.com].
146 National Football League and NFL Players Association, “NFL and NFL Players
Association Expands Disability Benefits Program for Retired Players,” p. 3. (Boldface
included in original.)

CRS-48
Other Efforts to Aid Former Players
Selected Organizations and Websites
Several former players and other individuals have established organizations or
websites with the goal of aiding retired players. Examples of these organizations and
websites include the following:
! Dignity After Football Inc. This organization is “committed to
giving a voice to past heroes of the NFL and to finally restoring
dignity to the lives of thousands of disabled and under-pensioned
former players.”147
! Fourth & Goal. Bruce Laird, a former NFL player, founded this
organization to assist retired players.148
! Gridiron Greats. “The Gridiron Greats Assistance Fund is a
non-stock, non-profit corporation that has been established to
provide financial assistance and coordination of social services to
retired players who are in dire need due to a variety of reasons
including inadequate disability and/or pensions.”149
! Hall of Fame Enshrinee Assistance Fund. One of the objectives of
this organization “is to help its own by offering support to former
pros experiencing financial or medical hardship.”150
! Hall of Fame Players Association. One of the association’s six
purposes is to “assist Hall [of Fame] members who have financial
difficulties.”151 Established in 2001, the Hall of Fame Players
Association (HOFPA) Charitable Foundation “will contribute to
local and national charities, create a relief fund for members who are
in need and support awards and scholarship efforts in selected
regional areas.”152
1 4 7 Di gni t y Af t er Foot b a l l In c . , “ M i s s i o n , ” n.d., available at
[http://www.dignityafterfootball.org/].
148 Greg Johnson, “More NFL Players Donating Game Checks to Charity,” Los Angeles
Times, Dec. 12, 2007, available at [http://www.latimes.com/sports/football/nfl/
la-sp-nfl12dec12,1,1897270. story?coll=la-headlines-sports-nfl].
149 Gridiron Greats, “About the Gridiron Greats Fund,” available at
[http://www.gridirongreats.org/aboutthefund.html].
150 NFL Alumni, “Mission Statement,” available at [http://www.nflalumni.org/].
151 Hall of Fame Players Association, “About Us,” available at [http://www.hofplayers.com/
index.asp?PageAction=Custom&ID=15].
152 Hall of Fame Players Association, “Charities,” available at [http://www.hofplayers.com/
index.asp?PageAction=Custom&ID=140].

CRS-49
! The John Mackey Fund, Inc. The fund was established “to raise
public awareness and fund research to find a cure for Frontotemporal
Dementias.”153
! NFL Alumni Association’s Dire Need Fund. This is a joint effort of
the NFL and NFL alumni to provide “assistance to former NFL
players and coaching staff members experiencing financial or
medical hardship.”154
! Ralph Wenzel Trust. The trust was established initially to receive
donations to help cover expenses for the care of Wenzel, who suffers
from Alzheimer’s-type dementia. Wenzel now participates in an
NFL program 155 that pays for a portion of his care, so the website
continues as a tribute to Wenzel and as a means of collecting
information about problems faced by former football players.156
! Retired Professional Football Players for Justice. This website was
created “to inform former football players, fans and supporters of the
actions being taken by retired players to collect what they fairly
deserve, but that has not been distributed by the organizations that
claim to be acting in the players’ best interest.”157
Active Players’ Efforts
In fall 2007, a lineman for the Kansas City Chiefs, Kyle Turley, announced that
he would donate his paycheck from his team’s game on December 23 to help retired
players who are in need. Reportedly, Turley talked to approximately 20 players who
said they will donate to Gridiron Greats, and he sent a letter to other players in late
November on the subject of donations.158 Turley is quoted, in a New York Times
article, as saying: “Are we going to wait until guys die? Are we going to wait until
guys commit suicide before we make a difference and change this thing?” [He
added:] “If this system doesn’t get fixed, no matter how much money you make ...
you are a serious surgery away from being broke.”159 At least 12 other active players
also have contributed funds to Gridiron Greats, and Turley’s goal is to raise $8
153 The John Mackey Fund, Inc., available at [http://johnmackeyfund.org/].
154 NFL Alumni, “NFL Alumni Dire Need Charitable Trust,” available at
[http://www.nflalumni.org/dire_need.html].
155 This statement may be a reference to the 88 Plan.
156 Ralph Wenzel Trust, available at [http://www.ralphwenzeltrust.org].
157 Retired Professional Football Players for Justice, “About Us,” available at
[http://www.playersforjustice.org/aboutus.html].
158 “N.F.L. Players Plan to Donate to Retirees,” New York Times, Nov. 27, 2007, available
at [http://www.nytimes.com/aponline/sports/AP-FBN-NFL-Disability.html?ex=
1353906000&en=8264ea3f9c77d661&ei=5088&partner=rssnyt&emc=rss].
159 Ibid.

CRS-50
million, according to another news article.160 Additionally, it has been reported that
former tennis player John McEnroe, former NBA player Charles Barkley, and sports
broadcaster Bob Costas have indicated that they will donate money to Gridiron
Greats.161
NFL and NFLPA Health and Safety Initiatives
As noted in the introduction to this report, a former player’s disabilities (as
interpreted broadly) or chronic health problems might, in some cases, have their
origins in what occurred, or did not occur, while the individual was an active player
in the NFL. A potentially significant factor for active players is the NFL’s and the
NFLPA’s efforts to safeguard their health, safety, and general welfare. Such efforts
may include, at a minimum: (1) keeping players informed of, and actively soliciting
their suggestions and ideas on, health and safety issues and initiatives; (2) helping
players prepare for the rigors of playing professional football; (3) identifying and
mitigating all possible conditions and factors that could affect a player’s health and
safety; and (4) upon being made aware of a potentially unsafe or unhealthful
condition, practice, piece of equipment, or rule or guideline, for example — which,
in any case, could involve an act committed or omitted — acting in a timely fashion
to remedy the situation. Some health or safety problems, such as excessive weight,
concussions, and injuries to joints, might have significant, long-term implications
for players. Thus, a comprehensive approach to the health and safety of players
might also include research that examines the possible long-term effects or
consequences of the different types of injuries sustained by players.162
The material in this next section describes the league’s and the players
association’s health and safety initiatives.

NFL Injury and Safety Panel
The NFL Injury and Safety Panel was founded in 1993. The panel
! “developed and manages an injury surveillance system that reports
the types and severity of injuries that players experience each year.
These reports are used by team medical staffs to assist in injury
prevention and treatment, and by the Competition Committee to
160 Pat Borzi, “Fund for N.F.L. Retirees in Need of Help Is Gaining Support,” New York
Times, Dec. 12, 2007, available at [http://www.nytimes.com/2007/12/12/sports/
football/12veterans.html]; Greg Johnson, “More Players Donating Game Checks to
C h a r i t y , ” L o s A n g e l e s T i m e s , D e c . 1 2 , 2 0 0 7 , a v a i l a b l e a t
[http://www.latimes.com/sports/football/nfl/la-sp-nfl12dec12,1,1897270.story?coll=
la-headlines-sports-nfl&ctrack=1&cset=true].
161 Ibid.
162 As noted below, the NFL is planning to request or sponsor a study on the long-term
effects of concussions.

CRS-51
assist in the development of playing rules that promote safety. Rules
and enforcement are reviewed annually...”; and the panel163
! “evaluates proposals and makes recommendations regarding grants
to support research.”164
The NFL has had the injury surveillance system since 1980, and team physicians and
athletic trainers use it “to record data on injured players and circumstances
surrounding injuries.”165 The league produces two reports each year — one
approximately midway through the regular season and the other after the Super Bowl
— that are detailed medical analyses of the data submitted to, and maintained in, the
injury surveillance system. The NFL provides a copy of each report to the NFLPA.166
The panel’s Subcommittee on Foot and Ankle Injuries, which was founded in
2005, “collects and analyzes injury data on foot and ankle injuries, works with shoe
manufacturers to encourage the development of more protective equipment, and
educates team equipment managers and medical staffs on these matters. The
subcommittee has commissioned studies by Boise State University and Michigan
State University analyzing how shoe and turf factors related to these injuries.”167
The NFL does not know how many players decided to retire because of injuries
they sustained while playing football. However, the league estimates that 181 players
who retired during the period 1993-2004 may have done so because of such
injuries.168
NFL Cardiovascular Health Committee
The Cardiovascular Health Committee, which was established in 2004, consists
of team physicians, athletic trainers, and experts in “cardiology and cardiovascular
163 Letter from Goodell to Reps. Conyers and Smith, p. 8.
164 Ibid.
165 Elliot J. Pellman, et al., “Concussion in Professional Football: Epidemiological Features
of Game Injuries and Review of the Literature,” Neurosurgery, vol. 54, no. 1, Jan. 2004, p.
82.
166 Personnel affiliated with the NFL have used data from the injury surveillance system for
articles on NFL players and health issues. For example, see the preceding footnote.
Additionally, data from the surveillance system were used in this article: Bryan T. Kelly, et
al., “Shoulder Injuries to Quarterbacks in the National Football League,” American Journal
of Sports Medicine, vol. 32, no. 2, 2004, pp. 328-331.
167 Ibid., p. 9.
168 Ibid. The basis for the league’s “assessment” is that 181 players received additional
compensation that is available or provided to players who do not “pass their pre-season
physical due to an injury sustained during the prior season and thus [are] unable to play.”
(Letter from Goodell to Reps. Conyers and Smith, p. 9.)

CRS-52
medicine, endocrinology and obesity, sleep medicine and cardiovascular disease
epidemiology.”169 The committee’s objectives are to investigate
the prevalence of cardiovascular risk factors in NFL players, including
hypertension, diabetes, sleep apnea and obesity; [assess] how those risk factors
relate to different body types and positions on the field; and [evaluate] the effect
of cardiovascular risks on various aspects of an NFL player’s life, such as
aerobic training, nutrition, family history and demographics.170
This committee also oversees the CVH program, which involves screening and
education, for retired players.171
NFL Medical Research Grants
Through NFL Charities, a nonprofit organization that was established in 1973,
the NFL awards charitable grants for sports-related medical research.172 Nonprofit
educational and research institutions may apply for these grants, the focus of which
must be “sports injury prevention, injury treatment, [or] other related research that
affects the health and performance of athletes.”173 Within the category of sports-
related medical research grants, there are four subcategories: education, medical,
MTBI, and scientific research. The following list shows what types of research or
activities have been funded by each grant subcategory:
! Education grants are used to fund the National Athletic Trainers’
Association Non-Medical Research and Scholarship Fund, the
annual meeting of the NFL Physicians Society, and the Professional
Football Athletic Trainers Society Foundation’s Ethnic Minority
Scholarship Program.
! Medical grants are used to pay the manager of the NFL’s injury
surveillance system and to pay for studies on concussions and
cardiovascular disease.
! MTBI grants have paid for studies involving concussions and related
subjects.
169 Ibid., pp. 6-7. The former commissioner of the NFL selected the co-chairmen who, in
turn, selected the other members of the committee. (Ibid., p. 7.)
170 Ibid.
171 Ibid.
172 National Football League, NFL Charities, “NFL Charities Grant Guidelines,” available
a t [ h t t p : / / w w w . n f l p a . o r g / p d f s / C h a r i t y W o r k /
2006NFLCHARITIESGRANTGUIDELINES.pdf], downloaded Sept. 2007, on file with the
author.
173 National Football League, “NFL Charities, Medical Research Grants,” available at
[http://www.jointheteam.com/programs/program.asp?p=39&c=6].

CRS-53
! Scientific research grants have funded studies on, for example,
arthritis, heat illness, orthopedic injuries and treatments, and cardiac
disease.174
Table 7 shows the amount of money awarded for grants in each of the four
subcategories.
Table 7. NFL Charities’ Grants for Research Related to Players’
Health, 2003-2007
Total Amount of Grants by Subcategory
Year
Scientific
Education
Medical
MTBI
Research
2003
$65,000
$70,935
$200,000
$5,126,666
2004
$92,000
$70,935
$180,000
$862,825
2005
$92,000
$263,715
$200,000
$1,182,900
2006
$92,000
$502,385
$345,900
$1,154,875
2007
$112,000
$1,184,030
$100,000
$1,230,073
Total
$453,000
$2,092,000
$1,025,900
$5,126,666
Source: Letter from Roger Goodell, Commissioner, National Football League, to Reps. John
Conyers, Jr., and Lamar S. Smith, Nov. 2, 2007, attachment 8.
The percentage of total funds awarded for grants, by subcategory and in
descending order, is: scientific research, 59%; medical, 24%; mild traumatic brain
injury, 12%; and education, 5%. Although the percentage of funds for MTBI grants
might seem relatively small, some medical grants have been awarded for research
into concussions, and the league’s MTBI Committee has conducted numerous studies
(see below and Appendix B).
NFL Mild Traumatic Brain Injury Committee
The Committee on Mild Traumatic Brain Injury was established in 1994, by
then-Commissioner Paul Tagliabue. After addressing the definition of “concussion,”
undertaking an effort to collect data, and reviewing available safety equipment, the
committee recommended to the commissioner that
the NFL should independently fund scientific research that would enable
scientists to better understand the cause(s) of MTBI; that this research should be
174 Letter from Goodell to Reps. Conyers and Smith, attachment 8.

CRS-54
funded to independent scientific researchers; and that the NFL Mild Traumatic
Brain Injury Committee should be charged with oversight of the project.175
To date, the committee has published 14 studies, all in the journal Neurosurgery, and
has contributed to “the development of a clearer understanding of the nature of
concussions in football, how they are caused, and the types of impacts that are more
likely to result in concussions.”176 The National Operating Committee on Standards
for Athletic Equipment (NOCSAE), which, among other things, develops standards
for and tests football helmets, and helmet manufacturers have received the
committee’s research.177
A list of members of the committee, and their professional affiliations, is found
in Appendix C.
NFL and NFLPA Education Efforts for Players
Although the NFL has noted that “education regarding injuries and related
matters is principally done by team medical staffs,”178 the league has provided some
information to players. In addition to the information on concussions disseminated
by the league (see below), the NFL and the players association have prepared and
distributed information on their substance of abuse policy and program, and their
policy on anabolic steroids and related substances.179 Materials on heat and hydration
that were developed by the NFL Physicians Society have been shared with team
medical staffs.180
For its part, the NFLPA has stated that it “does not conduct any formalized
educational program for players concerning injuries, their treatment, or rehabilitation.
175 Elliot J. Pellman, “Background on the National Football League’s Research on
Concussion in Professional Football,” Neurosurgery, vol. 53, no. 4, Oct. 2003, pp. 797-798.
176 Letter from Goodell to Reps. Conyers and Smith, p. 5.
177 Ibid., pp. 5-6. Additional information about the National Operating Committee on
Standards for Athletic Equipment (NOCSAE) is available at [http://www.nocsae.org/].
178 Letter from Goodell to Reps. Conyers and Smith, p. 13.
179 The following substances are considered substances of abuse under the NFL-NFLPA
policy: alcohol (under certain circumstances), cocaine, marijuana, amphetamine and its
analogues, opiates, phencyclidine (PCP), and methylenedioxymethamphetamine (MDMA)
and its analogues. (National Football League and NFL Players Association, National
Football League Policy and Program for Substances of Abuse, 2007, available at
[http://www.nflplayers.com/images/pdfs/RulesAndRegs/Drug_Policy_2007.pdf], pp. 6, 20.)
The categories of prohibited substances included in the latter policy are anabolic agents
(steroids), masking agents, and certain stimulants. (National Football League and NFL
Players Association, National Football League Policy on Anabolic Steroids and Related
Substances 2007, 2007, available at [http://www.nflplayers.com/images/pdfs/
RulesAndRegs/BannedSubstances.pdf], pp. 13-16.) See CRS Report RL32894, Anti-Doping
Policies: The Olympics and Selected Professional Sports, by L. Elaine Halchin, for
additional information about the NFL’s steroids policy and doping in general.
180 Letter from Goodell to Reps. Conyers and Smith, p. 13.

CRS-55
Under the standard NFL Player Contract form, Club medical staff has full discretion
on the treatment of injuries, subject to the player’s right to a second opinion and the
right to choose his own surgeon should surgery become necessary.”181 The players
association provides free legal representation for grievances having to do with
injuries; includes information on injury grievances and related topics in the Player
Planner; maintains a list of physicians whom players may consult when seeking
second opinions; and, though union representatives, brings issues related to injuries
to the attention of the Joint Committee on Player Safety and Welfare.182
NFLPA Medical Consultant and Performance Consultant
The NFLPA’s medical consultant (or advisor) “participates in various studies
conducted by the NFL and helps monitor compliance with a set of medical guidelines
the NFL clubs have been advised to follow regarding acclimatization, emergency
medical care, heat prostration, and other medical issues.”183 It is unclear whether this
individual is responsible for monitoring each team’s compliance with the NFL’s
medical guidelines. In any case, the method used for monitoring, how often it occurs,
and whether the medical consultant has a staff to aid him or her are unclear.
The extent of the medical consultant’s responsibilities raises the following
questions. Does the medical advisor personally monitor the teams, perhaps visiting
each team on a regular basis; reviewing the team’s policies, protocols, and other
materials; reviewing a sample of players’ medical records to see how players were
treated; and talking with medical staff as well as players? Or do teams use a “self-
report” model for compliance, whereby team staff members submit a verbal or
written report to the medical advisor that indicates to what extent the team complies
with medical guidelines?
The performance consultant attends NFLPA’s annual meeting and “advises
player reps [representatives] on a variety of health-related issues, including
conditioning, rehabilitation of injuries, use of nutritional supplements, and proper
equipment.”184
181 Letter from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, pp. 30-31.
182 Ibid., p. 31. The Player Planner is an appointment book that the NFLPA provides to
players and that includes information about, for example, benefits, the NFLPA, and the NFL
season.
183 Ibid., p. 11. Dr. Thom A. Mayer, CEO and president of BestPractices and chairman,
Dept. of Emergency Medicine, Inova Fairfax Hospital, is the NFLPA’s medical consultant.
(Ibid.)
184 National Football League and NFL Players Association, NFL Collective Bargaining
Agreement, 2006-2012, p. 11. The players association’s performance consultant is Mark
Verstegen, founder and chairman, Athletes’ Performance, a personal training company.

CRS-56
NFL and NFLPA Joint Committee on
Player Safety and Welfare

The following excerpt from the CBA describes the committee’s composition,
responsibilities, and authority:
A Joint Committee on Player Safety and Welfare (hereinafter the “Joint/
Committee”) will be established for the purpose of discussing the player safety
and welfare aspects of playing equipment, playing surfaces, stadium facilities,
playing rules, player-coach relationships and any other relevant subjects. The
Joint Committee will consist of six members: three Club representatives (plus
advisors) and three NFLPA representatives (plus advisors). The Joint Committee
will hold two regular meetings each year on dates and at sites selected by the
Committee. Special meetings may be held at any time and place mutually
agreeable to the Committee. The Joint Committee will not have the power to
commit or bind either the NFLPA or the [NFL] Management Council on any
issue. The Joint Committee may discuss and examine any subject related to
player safety and welfare it desires, and any member of the Committee may
present for discussion any such subject. Any Committee recommendation will
be made only to the NFLPA, the Management Council, the Commissioner, or any
appropriate committee of the NFL; such recommendation will be given serious
and thorough consideration.185
Pursuant to the 2006-2012 CBA, an additional task was assigned to the committee,
which is as follows: “The NFLPA and the [NFL] Management Council agree that a
task for the Joint Committee to undertake promptly upon the execution of this
Agreement is a review of all current materials on the player safety aspects of player
equipment, playing surfaces, including artificial turf and other safety matters.”186
The NFLPA has the right to initiate an investigation “before the Joint
Committee if the NFLPA believes that the medical care of a team is not adequately
taking care of player safety.”187 Two or more neutral physicians will investigate the
issue raised by the NFLPA, write a report, and submit recommendations to the joint
committee within 60 days of being selected.188 If the NFLPA disagrees with the
outcome of this process, it is unclear what recourse, if any, the players association
has.
Although the joint committee has the authority to discuss virtually any subject
related to the safety and welfare of players, it does not appear to have the authority
necessary to implement any proposals or remedies it might develop. That is, the
committee may make recommendations to the NFLPA, the Management Council, the
Commissioner, or an NFL committee, but it does “not have the power to commit or
185 National Football League and NFL Players Association, NFL Collective Bargaining
Agreement, 2006-2012, p. 38.
186 Ibid.
187 Ibid., p. 39.
188 Ibid.

CRS-57
bind either” the players association or the Management Council on any issue.189 This
limitation on its authority may exist because any changes the committee proposes
possibly would have to be negotiated pursuant to the collective bargaining process.
On the other hand, this limitation might hamper the ability of the NFL and the
NFLPA to enact in a timely manner any rule or policy changes necessary to protect
the health and safety of the players. Moreover, whereas it appears that the joint
committee focuses exclusively on player safety and health, when a recommendation
made by the committee is forwarded to one or more of the other parties, it is unclear
what other factors, interests, or considerations might be raised by these other parties
when discussing the committee’s recommendation.
The joint committee also has a role to play if the NFLPA believes that any
proposed playing rule changes, which are issued following the NFL’s annual
meeting, would adversely affect player safety. The process is as follows:
If the NFLPA believes that the adoption of a playing rule change would
adversely affect player safety, then within seven days of receiving such notice the
NFLPA may call a meeting of the Joint Committee [on Player Safety and
Welfare] to be held within one week to discuss such proposed rule change.
Within five days after such meeting, if the NFLPA continues to believe that the
adoption of a playing rule change would adversely affect player safety, the
NFLPA may request an advisory decision by one of the arbitrators designated in
Article IX [of the CBA]. A hearing before such arbitrator must be held within
seven days of the Joint Committee meeting and the arbitrator must render his
decision within one week of the hearing. No such playing rule change will be
made by the Clubs until after the arbitrator’s advisory decision unless the
arbitrator has not rendered his decision within one week of the hearing. The
arbitrator’s decision will be advisory only, not final and binding. Except as so
limited, nothing in this section will impair or limit in any way the right of the
Clubs to make any playing rule change whatsoever.190
While the joint committee’s role in this type of situation is relatively minor, the
description of the process for addressing rule changes that might adversely affect
player safety shows that, ultimately, neither the joint committee, the players
association, nor the arbitrator has any capability to modify or rescind a potentially
problematic proposed rule change. It is not known how many rule changes, if any,
were enacted despite the objections of the NFLPA. Conversely, considering the
following excerpt from the CBA, it appears that the NFLPA is not included in the
process for proposing new rules and thus cannot propose any rules directed at
improving player safety, let alone participate in discussions of rules proposed by the
NFL and/or teams: “Immediately following the NFL annual meeting, the NFLPA will
be given notice of all proposed playing rule changes, either tentatively adopted by the
Clubs or put over for further consideration at a later league meeting.”191
189 Ibid., p. 38.
190 Ibid., pp. 38-39.
191 Ibid., p. 38.

CRS-58
Discussion of Selected Issues
Injuries and Financial Considerations
Anecdotal accounts suggest that a player might be concerned that, if he is unable
to play because of an injury, his compensation, or his position on the team, might be
jeopardized. Faced with one or more possible financial disincentives, a player might
choose, then, to conceal an injury and continue to play, thus risking further injury.
Moreover, by delaying or not seeking treatment — or even by downplaying the
severity of his injury — a player may not receive appropriate, effective medical
treatment. The lack of medical treatment, or even just the lack of timely medical
care, could have long-term health consequences. Even if a player considers this
possibility, the immediate financial incentives of continuing to play might outweigh
concerns about possible long-term consequences, particularly since those
consequences might not be well known and might be unlikely to occur.
A player does have a financial incentive to report an injury, but this incentive
is relatively small. Failure to promptly report an injury to a club physician trainer
may result in a fine of up to $1,500.192 The financial penalty for failing to report an
injury promptly might be less important to a player than the perception, if not the
reality, of potential adverse financial consequences related to his willingness to play
while injured. If an individual continues to play with an injury, an action that can be
facilitated by the use of pain medications, it is possible that he risks aggravating the
original injury, or that other parts of his body may be forced to compensate for the
injured body part. A possible long-term consequence is that, since the injury is not
part of the player’s medical records, he might not have documentation he will need
as a former player to be eligible for retirement plan disability benefits.
Anecdotal information, in the form of statements by players that have been
reported in news articles, suggests that the perception exists among at least some
players that, in some cases or situations, a player who reports an injury might be
jeopardizing his career.193 Bob Brudzinski, who was a linebacker for the then-Los
Angeles Rams and Miami Dolphins, was quoted as saying
I can’t say the owners and coaches didn’t care. They wanted to see how tough
you are. Anybody can play not injured. They wanted to see if you can play
injured. There were a lot of injections and stuff like that. And the other thing
is, you didn’t want to sit out a game, because there’s always somebody behind
you who can take your spot. I never thought about concussions, never thought
about blowing my knee out. The one thing I wish is that I could remember more.
We used our head too much, in the wrong way.194
Another player, Jim Kelly, former quarterback for the Buffalo Bills, reportedly said
192 Ibid., p. 19.
193 Dustin Dow, “Much Pain, No Gain?” Cincinnati Enquirer, July 1, 2007, available at
[http://www.factiva.com/].
194 Brown, “Ex-Players Dealing With Not-So-Glamorous Health Issues.”

CRS-59
The game is played with pain.... If you can’t play in pain you should be playing
golf, like I’m doing now. I think that’s the mentality of players. There’s a lot at
stake. Big contracts, the pressure of losing your job — a lot of things force some
guys to do things that maybe they shouldn’t do. I know I played in a lot of games
that I should not have been playing in, but I did.195
Referring to the use of painkillers in order to keep playing, an unnamed
offensive lineman was quoted in a news article as saying: “When you have 300-
pound guys smashing into one another, what do people expect? People just see
Sundays, but we hit each other every day.... Ultimately, players take them to stay on
the field. Basically you’re in a very competitive sport that is cutthroat. There is little
tolerance for someone who’s not playing.”196 A former linebacker for the San
Francisco 49ers, Dan Bunz, reportedly said, “The coaches dangled that carrot — if
you’re not ready to play, you’re going to get cut [....] They just wanted you back on
the field. They don’t care about you, they just care about the game.”197
The following comments by a former linebacker for the Cleveland Browns,
Randy Gardner, suggest that performance incentives (which are discussed below)
might contribute to the problem of playing injured: “‘You have guys who have a lot
of incentives based upon playing time, you know? How many catches, maybe, how
many tackles — whatever is written into contracts.... And if you don’t meet that, you
lose out on a lot of money. Guys understand that. They push themselves through the
injuries, you know, in order to play and pretty much just to keep their jobs.” 198
Comments by the former director of football operations for the Pittsburgh
Steelers, are consistent with the concerns expressed by players. As quoted in a
Washington Post article, Tom Donahoe said: “‘Durability becomes a significant
factor because there is so much money involved.... If a guy misses five or six games
a year, you’ll think about whether you want to sign him. And I don’t know about all
coaches, but many would rather have a guy with less talent who is more dependable
than a more talented guy who you don’t know when he’ll show up.”199
195 Mike Freeman, “Painkillers, and Addiction, Are Prevalent in N.F.L.,” New York Times,
Apr. 13, 1997, available at [http://query.nytimes.com/gst/fullpage.html?res=
950CE7DD1F3CF930A25757C0A961958260].
196 Ibid. The player who made this comment was not identified in the article.
197 Ron Kroichick, “Glory Has Its Price: The 1981 49ers, Dan Bunz: Pain, Personal Welfare
No Match for Pressure to Play On,” San Francisco Chronicle, Jan. 21, 2007, available at
[http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/01/21/SPG0ANLFN11.DTL].
198 Carl Prine, “Finances Worsen Woes, Critics Say” Pittsburgh Tribune-Review, Jan. 9,
2005, available at [http://www.pittsburghlive.com/x/pittsburghtrib/news/specialreports/
specialnfl/s_291052.html], p. 4.
199 Dave Sell, “Football’s Pain-Taking Process; Playing Hurt Can Be a Complicated
Decision,” Washington Post, Dec. 8, 1996, p. D1.

CRS-60
Some observers might attribute the players’ comments and concerns to the lack
of “guaranteed contracts” in the NFL.200 There is no definition of a “guaranteed
contract,” but the term is taken to mean that a player who has a guaranteed contract
will continue to receive some or all of his compensation even if he is, for example,
injured and thus unable to play. The following excerpts from the NFL Player
Contract, which permit a team to terminate a player’s contract for reasons having to
do with, among other things, the player’s physical condition and performance, may
contribute, at least in part, to the notion that players in the NFL do not have so-called
guaranteed contracts:
8. PHYSICAL CONDITION. Player represents to Club that he is and will
maintain himself in excellent physical condition. Player will undergo a complete
physical examination by the Club physician upon Club request, during which
physical examination Player agrees to make full and complete disclosure of any
physical or mental condition known to him which might impair his performance
under this contract and to respond fully and in good faith when questioned by the
Club physician about such condition. If Player fails to establish or maintain his
excellent physical condition to the satisfaction of the Club physician, or make the
required full and complete disclosure and good faith responses to the Club
physician, then Club may terminate this contract.
9. INJURY. Unless this contract specifically provides otherwise, if Player is
injured in the performance of his services under this contract and promptly
reports such injury to the Club physician or trainer, then Player will receive such
medical and hospital care during the term of this contract as the Club physician
may deem necessary, and will continue to receive his yearly salary for so long,
during the season of injury only and for no subsequent period covered by this
contract, as Player is physically unable to perform the services required of him
by this contract because of such injury. If Player’s injury in the performance of
his services under this contract results in his death, the unpaid balance of his
yearly salary for the season of injury will be paid to his stated beneficiary, or in
the absence of a stated beneficiary, to his estate.
11. SKILL, PERFORMANCE AND CONDUCT. Player understands that he is
competing with other players for a position on Club’s roster within the applicable
player limits. If at any time, in the sole judgment of Club, Player’s skill or
performance has been unsatisfactory as compared with that of other players
competing for positions on Club’s roster, or if Player has engaged in personal
conduct reasonably judged by club to adversely affect or reflect on Club, then
Club may terminate this contract. In addition, during the period any salary cap
is legally in effect, this contract may be terminated if, in Club’s opinion, Player
is anticipated to make less of a contribution to Club’s ability to compete on the
playing field than another player or players whom Club intends to sign or
attempts to sign, or another player or players who is or are already on Club’s
roster, and for whom Club needs room [under the salary cap].201
As discussed below, a player may have a “skill guarantee” or an “injury guarantee”
written into his contract that protects some or all of his compensation in the event his
200 E.M. Swift, “One Big Headache,” Sports Illustrated, Feb. 12, 2007, p. 23.
201 National Football League and NFL Players Association, NFL Collective Bargaining
Agreement, 2006-2012, pp. 252-253. (Italics added to aid in identifying significant text.)

CRS-61
skills decline or he sustains an injury that keeps him from playing, respectively.
The idea of a “guaranteed contract” is, perhaps, an overly broad concept for the
NFL, given the different ways in which player compensation may be structured.
Generally, the composition and amount of total compensation, and whether all or a
portion of the compensation is guaranteed, varies from player contract to player
contract. (Generally, a player has an agent who negotiates the terms of his contract
with the team. However, a player may negotiate his own contract.) A player’s total
compensation from the NFL may include, for example, salary, one or more bonuses,
and one or more incentives.202 Incentives are also known as performance bonuses;
however, not all bonuses are incentives. One of the better-known bonuses an NFL
player may have included in his contract is a signing bonus, which means he will
receive a bonus for signing his contract with the team. Some incentives are tied to
a team’s performance, such as “points scored by offense,” “points allowed by
defense,” and “[number of] sacks allowed.”203 Examples of individual incentives
include number of interceptions made, passer rating, and total number of
receptions.204 A portion of a player’s compensation might be guaranteed, depending
upon what was negotiated with the team, but how much is guaranteed, for what
reason or reasons, and for which year or years of the contract varies from player to
player.
It is difficult to know, then, how much of each player’s compensation from the
league is guaranteed and how much is not guaranteed. Without this information, and,
in particular, data that show how many players, if any, have none, or only a negligible
portion, of their NFL compensation guaranteed, it is difficult to know whether, and
how many, players could be at risk of adverse financial consequences if they are
unable to play because of injuries.205
202 Section 8 of Article XXXVIII of the CBA describes the different types of compensation
a player might be entitled to in addition to his salary: “A player will be entitled to receive
a signing or reporting bonus, additional salary payments, incentive bonuses and such other
provisions as may be negotiated between his Club (with the assistance of the [NFL]
Management Council) and the player or his NFLPA-certified agent.” (National Football
League and NFL Players Association, NFL Collective Bargaining Agreement, 2006-2012,
p. 180.)
203 Ibid., p. 111.
204 Ibid., p. 112. The incentives that are included in a player’s contract might serve as an
inducement to continue playing with an injury instead of seeking treatment, which might put
the player at risk for not meeting the goal(s) in one or more of his incentive clauses. A team
physician for the Pittsburgh Steelers, Jim Bradley, reportedly has suggested that “players
will beg doctors to get them back into a game so they can make the three catches needed to
trigger hundreds of thousands of dollars in incentive clauses in their contracts.... During
games, he has signaled trainers to hide an injured player’s helmet to prevent a return to the
field.” (Dan Vergano, “NFL Doctors, Players Face Off Over Painful Choices,” USA Today,
J an. 31, 2004, available at [ ht t p://www.usatoday.com/ news/health/
2002-01-31-football-medicine.htm].)
205 In the absence of comprehensive data, the long-term financial consequences for players
who sustain an injury or injuries, and, as a result, are unable to play, are unknown. The
(continued...)

CRS-62
Apparently, however, during the 2007 season, approximately 94% of NFL
players had only a portion, if any, of their compensation guaranteed. The NFLPA has
noted that, if “the term ‘guaranteed’ is defined as an individually negotiated clause
in a player’s contract that assures that he will receive all or most of his salary for the
term of the contract, even if he is unable to play due to injury or declining skills, only
about 6 per cent of all NFL player contracts are ‘guaranteed’.”206 This percentage
equates to approximately 102 players for the 2007 season.207 Looking further back,
“from the 1982 through 1992 seasons only eleven players had any of their base salary
guaranteed....” and “[t]he average number of players with guaranteed base salary
from 1995 through 2002 [was] 40 per season....”208
The NFLPA has noted, nevertheless, that signing bonuses are preferable to
salary guarantees, and has suggested, generally, that such bonuses equate to
guaranteed compensation. Specifically, the players association has stated that “a
signing bonus is far more preferable to a salary guarantee” for these reasons: the
money is given to the player “up front” (that is, “before he renders his services to the
club”); if the club wants some or all of the signing bonus returned (for example, if
the player fails to perform), the team “must legally prove its entitlement to a return
of any of that money”; and the player can invest the money as soon as he receives
it (unlike a salary, which is paid periodically).209 The NFLPA adds,
It should therefore be clear that signing bonuses, representing a more secure form
of compensation than the typical ‘guaranteed contracts’ in professional baseball
and basketball, more than qualify as ‘guaranteed’ compensation under any
definition of that term. In 2006, approximately 52% of all compensation paid to
players in the NFL was paid in the form of signing or similar bonuses or
205 (...continued)
actual consequences may differ from players’ perceptions, although an analysis performed
by the Pittsburgh Tribune-Review suggests that a connection might exist between sustaining
an injury and having one’s salary decreased. The Tribune-Review, which analyzed salary
and bonus data for 109 individuals who played for the Steelers during the period 1999-2003,
found that every game an injured player missed led to “nearly $73,000 [on average] in wage
concessions the next season.” (Prine, “Bloody Sundays.”)
206 NFL Players Association, “Guaranteed Contracts in Professional Team Sports: How Does
the NFL Compare?” NFLPA issue paper, n.d., p. 3.
207 The percentage was calculated using 1,696 as the total number of players (each of the 32
teams has a roster of 53 players).
208 NFL Players Association, “A New Look at Guaranteed Contracts in the NFL,” n.d.,
available at [http://www.nflpa.org/PDFs/Shared/Guaranteed_Contracts.pdf], downloaded
Sept. 2007, on file with the author. (Italics in original.)
209 NFL Players Association, “Guaranteed Contracts in Professional Team Sports: How
Does the NFL Compare?” p. 4. In this statement, “the term ‘signing bonus’ includes
bonuses which are either labeled as such or are payable ‘up front’ or with a similar degree
of certainty, such as first year roster bonuses, reporting bonuses, or option bonuses.” (Ibid.,
p. 4.)

CRS-63
guaranteed salary. In a very real sense, it can therefore be said that at least 52%
of all compensation in the NFL is, in fact, ‘guaranteed’ to players.210
Although, league-wide, 52% of all compensation in 2006 was virtually “guaranteed,”
this does not mean that 52% of each player’s compensation was “guaranteed.”
Variations among players’ contracts, specifically signing bonuses, provide a
better indication of each player’s financial status, and, as the NFLPA has suggested,
could indicate what portion of a player’s contract is “guaranteed.” The NFLPA
acknowledges that it “knows better than anyone that not all players can negotiate
large signing bonuses or otherwise lucrative contracts.”211 The size of a player’s
signing bonus might have some bearing on whether and how vulnerable a player
might be to internal or external factors inducing him to play when he is injured,
recognizing that an individual’s decision to play when injured could be the result of
a combination of many different factors or considerations.
Signing bonus data are presented in Tables 8 (1993-1997), 9 (1998-2002), and
10 (2003-2007). Each table shows, for each range of signing bonus amounts,
information regarding two groups of players: (1) players who received signing
bonuses; and (2) all players, including those who did not receive signing bonuses.
210 Ibid. See the preceding footnote for a description of what the NFLPA includes in the
term “signing bonus” in this context.
211 Ibid.

CRS-64
Table 8. Signing Bonuses Among NFL Players, 1993-1997
1993
1994
1995
1996
1997
Total Signing Bonusa
$183,413,792
$272,809,813
$460,308,221
$563,184,962
$523,047,173
Average Signing Bonus
$308,258
$271,723
$364,745
$480,533
$436,965
Total # of Signing Bonusesb
595
1,003
1,262
1,172
1,197
(40.0%)
(67.6%)
(79.4%)
(73.7%)
(75.3%)
Total # of NFL Playersc
1,484
1,484
1,590d
1,590
1,590
% of
% of
% of
% of
% of
% of
% of
% of
% of
% of
Players w/
Total
Players w/
Total
Players w/
Total
Players w/
Total
Players w/
Total
Bonus
Playerse
Bonus
Playerse
Bonus
Playerse
Bonus
Playerse
Bonus
Playerse
$1-$250,000
73.3
29.4
75.5
51.0
73.5
58.4
70.7
52.1
71.3
53.6
$250,001-$500,000
12.4
5.0
10.1
6.8
9.4
7.5
9.0
6.6
8.9
6.7
$500,001-$750,000
4.2
1.7
3.8
2.6
5.1
4.0
4.0
3.0
5.2
3.9
$750,001-$1,000,000
2.0
0.8
3.7
2.5
2.7
2.1
3.2
2.4
3.8
2.8
$1,000,001-$1,250,000
2.4
0.9
1.2
0.8
1.5
1.2
1.6
1.2
1.0
0.8
$1,250,001-$1,500,000
1.8
0.7
1.5
1.0
1.5
1.2
1.6
1.2
2.1
1.6
$1,500,001-$1,750,000
1.0
0.4
0.5
0.3
0.7
0.6
0.6
0.4
0.7
0.5
$1,750,001-$2,000,000
0.5
0.2
1.2
0.8
1.1
0.8
2.0
1.4
1.6
1.2
$2,000,001-$3,000,000e
1.0
0.4
1.6
1.1
2.6
2.1
3.8
2.8
2.7
2.0
$3,000,001-$4,000,000
0.5
0.2
0.5
0.3
1.0
0.8
1.0
0.8
1.2
0.9
$4,000,001-$5,000,000
0.4
0.1
0.4
0.3
0.4
0.3
1.1
0.8
0.7
0.5

CRS-65
1993
1994
1995
1996
1997
$5,000,001-$6,000,000
0.1
0.06
0.1
0.06
0.2
0.2
0.7
0.5
0.5
0.4
$6,000,001-$7,000,000
0
0
0
0
0.2
0.2
0.5
0.4
0.2
0.1
$7,000,001-$8,000,000
0
0
0
0
0.1
0.01
0
0
0.2
0.1
$8,000,001-$9,000,000
0
0
0
0
0
0
0
0
0
0
$9,000,001-$10,000,000
0
0
0
0
0
0
0
0
0.1
0.06
$10,000,001 +
0
0
0
0
0.2
0.2
0.1
0.06
0.2
0.1
Source: Information provided by the NFL Players Association to the author on Jan. 8, 2008; as described in table note e, some calculations performed by the author.
a. The term “signing bonus” “includes bonuses which are either labeled as such or are payable ‘up front’ or with a similar degree of certainty, such as first year roster bonuses, reporting
bonuses, or option bonuses.” (NFL Players Association, “Guaranteed Contracts in Professional Team Sports: How Does the NFL Compare?” NFLPA Issue Paper, n.d., p. 4.
Information provided by telephone by the NFL Players Association to the author on Jan. 15, 2008.) Although some signing bonuses may be multiyear, each signing bonus in
this table is included only in the year in which it was negotiated and agreed to.
b. Each percentage in this row is the percentage of the total number of players who received a signing bonus.
c. The total number of players was calculated by multiplying the number of teams by the number of players each team is permitted to have on its regular season and post-season roster,
which is 53.
d. Two expansion teams were added to the league in 1995: the Carolina Panthers and the Jacksonville Jaguars.
e. The percentage of total players was calculated in this manner: the figure in the column “% of Players w/Bonus” was multiplied by the “Total # of Signing Bonuses.” The result of
this calculation was rounded and then divided by the “Total # of NFL Players.” For example, for the year 1993, .733 (% of Players w/Bonus”) was multiplied times 595 (“Total
# of Signing Bonuses”). The result was 436.135, which was rounded to 436. Dividing 436 by 1,484 (“Total # of NFL Players”) resulted in .2938, or 29.4%.

CRS-66
Table 9. Signing Bonuses Among NFL Players, 1998-2002
1998
1999
2000
2001
2002
Total Signing Bonusa
$831,580,214
$953,514,150
$1,052,590,699
$973,098,236
$857,847,526
Average Signing Bonus
$710,145
$767,107
$788,457
$784,124
$689,588
Total # of Signing Bonusesb
1,171
1,243
1,335
1,241
1,244
(73.6%)
(75.7%)
(81.3%)
(75.5%)
(73.3%)
Total # of NFL Playersc
1,590
1,643d
1,643
1,643
1,696e
% of
% of
% of
% of
% of
% of
% of
% of
% of
% of
Players w/
Total
Players w/
Total
Players w/
Total
Players w/
Total
Players w/
Total
Bonus
Playerse
Bonus
Playerse
Bonus
Playerse
Bonus
Playerse
Bonus
Playerse
$1-$250,000
66.6
49.1
63.0
47.7
62.5
50.8
62.9
47.5
67.8
49.7
$250,001-$500,000
8.3
6.1
8.9
6.8
9.4
7.6
9.2
6.9
8.4
6.1
$500,001-$750,000
4.7
3.5
3.7
2.8
3.1
2.5
4.4
3.3
3.2
2.4
$750,001-$1,000,000
3.2
2.3
4.2
3.2
4.0
3.2
2.6
1.9
2.6
1.9
$1,000,001-$1,250,000
1.6
1.2
1.9
1.5
2.2
1.8
1.8
1.3
1.8
1.3
$1,250,001-$1,500,000
1.6
1.2
2.5
1.9
2.6
2.1
3.0
2.3
2.4
1.8
$1,500,001-$1,750,000
0.9
0.7
2.3
1.8
2.0
1.6
1.0
0.7
1.4
1.0
$1,750,001-$2,000,000
1.5
1.1
2.3
1.8
2.0
1.6
2.0
1.5
1.6
1.2
$2,000,001-$3,000,000
3.7
2.7
3.7
2.8
4.6
3.7
5.3
4.0
3.9
2.9
$3,000,001-$4,000,000
4.0
3.0
2.7
2.1
2.5
2.0
3.3
2.5
2.7
2.7
$4,000,001-$5,000,000
1.2
0.9
2.3
1.8
2.1
1.7
1.3
1.0
1.3
0.9

CRS-67
1998
1999
2000
2001
2002
$5,000,001-$6,000,000
0.9
0.7
0.6
0.4
0.7
0.5
1.0
0.7
1.1
0.8
$6,000,001-$7,000,000
0.3
0.3
0.6
0.4
0.7
0.5
0.4
0.3
1.0
0.7
$7,000,001-$8,000,000
0.8
0.6
0.4
0.3
0.5
0.4
0.5
0.4
0.1
0.06
$8,000,001-$9,000,000
0.2
0.1
0.3
0.2
0.2
0.2
0.5
0.4
0.1
0.06
$9,000,001-$10,000,000
0.2
0.1
0.2
0.1
0.3
0.2
0.2
0.1
0.4
0.3
$10,000,001 +
0.4
0.3
0.5
0.4
0.5
0.4
0.5
0.4
0.4
0.3
Source: Information provided by the NFL Players Association to the author on Jan. 8, 2008; as described in table note f, some calculations performed by the author.
a. The term “signing bonus” “includes bonuses which are either labeled as such or are payable ‘up front’ or with a similar degree of certainty, such as first year roster bonuses, reporting
bonuses, or option bonuses.” (NFL Players Association, “Guaranteed Contracts in Professional Team Sports: How Does the NFL Compare?” NFLPA Issue Paper, n.d., p. 4.
Information provided by telephone by the NFL Players Association to the author on Jan. 15, 2008.) Although some signing bonuses may be multiyear, each signing bonus in
this table is included only in the year in which it was negotiated and agreed to.
b. Each percentage in this row is the percentage of the total number of players who received a signing bonus.
c. The total number of players was calculated by multiplying the number of teams by the number of players each team is permitted to have on its regular season and post-season roster,
which is 53.
d. One team was added to the league in 1999 with the re-activation of the Cleveland Browns franchise. (The original Cleveland team was moved, by its owner, to Baltimore in 1995,
and became the Baltimore Ravens.)
e. One expansion team was added to the league in 2002, the Houston Texans.
f. The percentage of total players was calculated in this manner: the figure in the column “% of Players w/Bonus” was multiplied by the “Total # of Signing Bonuses.” The result of
this calculation was rounded and then divided by the “Total # of NFL Players.” For example, for the year 1998, .666 (“% of Players w/Bonus”) was multiplied times 1,171 (“Total
# of Signing Bonuses”). The result was 779.886, which was rounded to 780. Dividing 780 by 1,590 (“Total # of NFL Players”) resulted in .4906, or 49.1%.

CRS-68
Table 10. Signing Bonuses Among NFL Players, 2003-2007
2003
2004
2005
2006
2007
Total Signing Bonusa
$833,446,205
$989,681,552
$775,180,194
$908,253,709
$898,656,147
Average Signing Bonus
$701,554
$882,069
$746,083
$889,759
$889,759
Total # of Signing Bonusesb
1,188
1,122
1,039
1,069
1,010
(70.0%)
(66.2%)
(61.3%)
(63.0%)
(59.6%)
Total # of NFL Playersc
1,696
1,696
1,696
1,696
1,696
% of
% of
% of
% of
% of
% of
% of
% of
% of
% of
Players w/
Total
Players w/
Total
Players w/
Total
Players w/
Total
Players w/
Total
Bonus
Playersd
Bonus
Playersd
Bonus
Playersd
Bonus
Playersd
Bonus
Playersd
$1-$250,000
65.1
45.6
61.6
41.0
65.0
40.0
62.3
39.3
64.6
38.4
$250,001-$500,000
9.7
6.8
9.2
6.1
9.3
5.7
9.4
5.9
9.5
5.7
$500,001-$750,000
4.0
2.8
5.0
3.3
3.8
2.3
4.3
2.7
3.8
2.2
$750,001-$1,000,000
3.1
2.2
2.9
1.9
4.2
2.6
3.4
2.1
4.0
2.4
$1,000,001-$1,250,000
1.8
1.2
2.3
1.5
1.6
1.0
1.9
1.2
1.6
0.9
$1,250,001-$1,500,000
2.8
1.9
2.6
1.7
2.6
1.6
2.2
1.4
2.2
1.3
$1,500,001-$1,750,000
1.6
1.1
1.2
0.8
1.1
0.6
1.3
0.8
0.6
0.4
$1,750,001-$2,000,000
2.2
1.5
2.1
1.4
2.3
1.4
2.6
1.7
1.8
1.1
$2,000,001-$3,000,000
3.8
2.6
4.7
3.1
2.9
1.8
4.1
2.6
3.8
2.2
$3,000,001-$4,000,000
1.6
1.1
2.6
1.7
2.1
1.3
2.5
1.6
1.9
1.1
$4,000,001-$5,000,000
1.4
1.0
1.8
1.2
1.5
0.9
2.3
1.5
1.5
0.9

CRS-69
2003
2004
2005
2006
2007
$5,000,001-$6,000,000
0.9
0.6
1.0
0.6
1.1
0.6
1.0
0.6
1.3
0.8
$6,000,001-$7,000,000
0.4
0.3
0.8
0.5
1.2
0.7
0.8
0.5
0.7
0.4
$7,000,001-$8,000,000
0.4
0.3
0.7
0.5
0.1
0.05
0.7
0.4
0.6
0.4
$8,000,001-$9,000,000
0.2
0.1
0.6
0.4
0.5
0.3
0.3
0.2
0.2
0.1
$9,000,001-$10,000,000
0.5
0.4
0.2
0.1
0.2
0.1
0.2
0.1
0.7
0.4
$10,000,001 +
0.5
0.4
0.7
0.5
0.5
0.3
0.8
0.5
1.5
0.9
Source: Information provided by the NFL Players Association to the author on Jan. 8, 2008; as described in table note d, some calculations performed by the author.
a. The term “signing bonus” “includes bonuses which are either labeled as such or are payable ‘up front’ or with a similar degree of certainty, such as first year roster bonuses, reporting
bonuses, or option bonuses.” (NFL Players Association, “Guaranteed Contracts in Professional Team Sports: How Does the NFL Compare?” NFLPA Issue Paper, n.d., p. 4.
Information provided by telephone by the NFL Players Association to the author on Jan. 15, 2008.) Although some signing bonuses may be multiyear, each signing bonus in
this table is included only in the year in which it was negotiated and agreed to.
b. The percentage in this row is the percentage of the total number of players who received a signing bonus.
c. The total number of players was calculated by multiplying the number of teams by the number of players each team is permitted to have on its regular season and post-season roster,
which is 53.
d. The percentage of total players was calculated in this manner: the figure in the column “% of Players w/Bonus” was multiplied by the “Total # of Signing Bonuses.” The result of
this calculation was rounded and then divided by the “Total # of NFL Players.” For example, for the year 2003, .651 (“% of Players w/Bonus”) was multiplied times 1,188 (“Total
# of Signing Bonuses”). The result was 773.338, which was rounded to 773. Dividing 773 by 1,696 (“Total # of NFL Players”) resulted in .4558, or 45.6%.

CRS-70
The percentage of total players who received a signing bonus each year varied
from a low of 40.0% in 1993 to a high of 81.3% in 2000. The largest change
between consecutive years was a 27.6 percentage point increase from 1993 (40.0%)
to 1994 (67.6%), which might be related to the approval of a new CBA in 1993. For
the period 1995-2003, the percentage was at or above 70.0%. However, after
reaching 81.3% in 2000, the percentages have declined each year so that, in 2007,
59.6% of total players received a signing bonus, which is a decrease of 21.7
percentage points since 2000. The signing bonus category, the range, and the
difference between the lowest and highest percentages are in Table 11.
Table 11. Range of Percentage of Total Players Who Received a
Signing Bonus, by Signing Bonus Amount
Range of Percentage of
Difference in Percentage
Amount of Signing Bonus
Total Players for the Years
Points Between Lowest and
1993-2007
Highest Percentage
$1-$250,000
29.4%-58.4%
29.0
$250,000-$500,000
5.0%-7.6%
2.6
$500,001-$750,000
1.7%-4.0%
2.3
$750,001-$1,000,000
0.8%-3.2%
2.4
$1,00,001-$1,250,000
0.8%-1.8%
1.0
$1,250,001-$1,500,000
0.7%-2.3%
1.6
$1,500,001-$1,750,000
0.3%-1.8%
1.5
$1,750,001-$2,000,000
0.2%-1.8%
1.6
$2,000,001-$3,000,000
0.4%-4.0%
3.6
$3,000,001-$4,000,000
0%-3.0%
3.0
$4,000,001-$5,000,000
0.1%-1.8%
1.7
$5,000,001-$6,000,000
0.06%-0.8%
0.74
$6,000,001-$7,000,000
0%-0.7%
0.7
$7,000,001-$8,000,000
0%-0.6%
0.6
$8,000,001-$9,000,000
0%-0.4%
0.4
$9,000,001-$10,000,000
0%-0.4%
0.4
$10,000,001+
0%-0.9%
0.9
Sources: Tables 8-10.
The largest percentage of players who received a signing bonus each year
received a bonus valued at $250,000 or less. The percentage of total players who
received an amount in this category ranged from 29.4%, in 1993, to 58.4%, in 1995.
Except for 1997 and 2000, the percentage steadily declined from 1995 through 2007.
The percentage dropped by 20.0 percentage points over this period. Consequently,

CRS-71
in 2007, the percentage (38.4%) is only 9.0 percentage points higher than the 1993
figure (29.4%). The percentages of total players who received other signing bonus
amounts experienced much smaller changes over the 15-year period. Thus, Table
11 shows that the overall decrease in the percentage of players who received signing
bonuses was due primarily to the steady decline in the percentage of players who
receive signing bonuses valued at $250,000 or less.
The nature of the game of football, and, in particular, the risk of injury and how
that risk is apportioned between players and teams appears to have some bearing on
how compensation is structured. News accounts regarding three players who had
sustained injuries — Wayne Chrebet, Matt Birk, and Dan Morgan — and how their
respective teams responded to their situations illustrates how risk is allocated
between the team and the player. A description of how then-New York Jet Wayne
Chrebet’s contract was re-structured shows the complexity of one player’s contract,
and illustrates how a team can protect itself financially. Of particular concern to the
team, apparently, was the number of concussions that Chrebet already had sustained;
reportedly, he had had at least six concussions by the time he retired several months
after the end of the 2005 season.212 The article on Chrebet’s “concussion clause”
stated the following:
Chrebet, signed through 2008, agreed to a $1.3 million pay cut that lowers his
base salary this season [2004] to $1.5 million, according to NFL Players
Association documents. The pay cut isn’t a surprise, considering Chrebet
probably will lose his starting job, but the new contract does include an injury-
related wrinkle. The Jets got Chrebet to sign a ‘split’ contract, a complicated
deal that would save them from having to pay his entire $1.5 million salary if
he’s placed on injured reserve with a concussion. Ordinarily, a player receives
his full salary on injured reserve. Clearly, the Jets are concerned that another
concussion would end Chrebet’s season — and quite likely his career. The
‘split’ salary, as negotiated by both parties, is $500,000. It means that, if Chrebet
were to land on injured reserve, his salary would drop to $500,000 from $1.5
million. Pro-rated over the course of a season, the difference is about $60,000
per week. The contract states that only a concussion, and no other injury, can
trigger the ‘split’ salary. To sweeten the deal for Chrebet, the Jets guaranteed
$500,000 of the $1.5 million salary. He receives that amount no matter what,
even if he’s not on the opening-day roster.213
In 2005, Matt Birk, a center for the Minnesota Vikings, considered how much
risk he wanted to take in continuing to play while injured, as recounted in a news
article.214 Although he had had three hernia operations and was experiencing chronic
212 William C. Rhoden, “A Jet Who Led with His Head, and His Heart,” New York Times,
Sept. 24, 2007, available at [http://www.nytimes.com/glogin?URI=http://www.nytimes.com/
2007/09/24/sports/football/24rhoden.html&OQ=_rQ3D1&OP=1744e5c7Q2FlOkAl6_Y
Rx__r7l7Q51Q51.lQ51Q27l7blRW_xrRlQ7E__rAyccl7bxQ5D_6kztQ5DrBc].
213 Rich Cimini, “Jets Give Chrebet Concussion Clause,” New York Daily News, Mar. 31,
2004, available at [http://www.nydailynews.com/archives/sports/2004/03/31/
2004-03-31_jets_give_chrebet_concussion.html].
214 Joseph Nocera, “The Union That Can’t Throw Straight,” New York Times, Sept. 17,
(continued...)

CRS-72
pain, Birk played in most games during the 2004-2005 season. At the beginning of
the 2005-2006 season, he asked the team to guarantee his salary for the 2006-2007
season. He offered to play injured — he had a hip injury — during the 2005-2006
season in exchange for guaranteed salary the following season. Reportedly, Birk
explained his reasoning as follows:
Playing with pain is part of the game.... But I felt that I had risked my career by
playing injured last year [2004], and probably shortened it. And I wasn’t willing
to do it again unless the team was going to assume some of the risk.” So he
asked the Vikings to guarantee the $3.94 million his contract called for him to
get next year [2006]. The Vikings declined. On Tuesday, Mr. Birk went under
the knife. He’s done for the season.215
Another player who, reportedly, had his contract restructured because of his team’s
concern about his history of concussions is Dan Morgan. The New York Times article
described his situation as follows:
... teams are wary of players with a history of concussions. An example is
Carolina Panthers linebacker Dan Morgan — who has sustained at least five
concussions but was cleared to continue playing — and faced being cut had he
not agreed to restructure his $2 million roster bonus into payments of $125,000
for each game he played. Beyond acknowledging the team’s concerns about
subsequent concussions, the contract gave Mr. Morgan financial incentive not to
reveal any concussion for treatment. Mr. Morgan has missed most of this season
[2007] with a torn Achilles’ tendon, and has declined interview requests by The
New York Times. Regarding the restructuring of his contract, Mr. Morgan told
The Herald of Rock Hill, S.C., “I didn’t have a problem with that, because that’s
just them protecting themselves.”216
Without data, it is impossible to know how many players have faced situations
similar to Chrebet’s, Birk’s, or Morgan’s; have obtained one or more guarantees in
their contracts; or have been unsuccessful in obtaining any type of guarantees.
Andrew Zimbalist, an economics professor at Smith College who has written
extensively on sports economics, summarized the situation in the NFL: “‘The lack
of guaranteed contracts is a natural outcome of football players getting hurt’.”217 In
a similar vein, the NFL Players Association offered this explanation for “no-cut”
contracts (that is, contracts that do not include any guarantees):
There’s no argument that no-cut contracts in the NFL have been a rarity. For a
lot of reasons. Mainly, owners just said “No.” That’s the way “Things had
always been” and traditionally owners held virtually all of the leverage in
contract negotiations. That meant that players, who rarely — if ever — had a
214 (...continued)
2005, p. C1.
215 Ibid.
216 Alan Schwarz, “For Jets, Silence on Concussions Signals Unease,” New York Times, Dec.
22, 2007, p. A20.
217 Nocera, “The Union That Can’t Throw Straight.”

CRS-73
viable alternative if they wanted to have a pro football career, were forced to sign
a series of one year non-guaranteed contracts. The NFL was “unique,” owners
argued, because injury rates to players (who, ironically took all the risks) were
so high that there was no desire to have [to] keep on paying players no longer in
the league.218
If injury risk were re-allocated and the compensation structure were altered
accordingly, players might be less likely to play with injuries, which would benefit
them immediately, and might also positively affect their long-term health. On the
other hand, NFL teams might be adversely affected if they were required to bear more
of the risk related to injuries than they do presently. A team cannot pay its players
more than the NFL-established salary cap each year.219 The existence of a salary cap
means that a team would be unable to hire and pay additional players to play in place
of injured players while it continues to pay the salaries of the injured players. A
related problem is that a team may be unwilling or unable financially to pay the
salaries of more than 53 players (a team can have only 53 players on its regular
season and postseason rosters). The NFLPA describes this dilemma for teams as
follows:
In the NFL, the salary cap rules require that any salary paid in a given year must
count against the cap for that year even if the player is no longer playing. If a
team has a large number of guaranteed contracts, a rash of injuries to players
covered by those contracts could cause severe cap problems for the team and
diminish its ability to compete with healthy players on the field.220
A journalist for The New York Times explains further how “guaranteed contracts”
could adversely affect a team’s ability to maintain a competitive team:
... there are seasons when dozens of players on one roster will miss at least some
games because of injury. If football teams had to pay every player whose
abilities were diminished as a result of injury, or had to continue paying a player
who had suffered a career-ending injury, there is no way they’d be able to stay
218 NFL Players Association, “A New Look at Guaranteed Contracts in the NFL.” A related
issue is the length of contracts: “Fans often read about multiyear deals, but NFL
compensation packages are really a series of one-year contracts. Because of career-ending
injuries, players increasingly rely on signing bonuses struck at the beginning of the contract
and performance incentives after they take the field. Signing bonuses now constitute half
of a player’s take-home pay, according to the National Football League Player’s
Association.” (Prine, “Bloody Sundays.”) Reportedly, the rationale offered by an employee
of the NFL for one-year contracts is as follows: “The NFL is a competitive sports league ....
We put the world’s best athletes on the field, so it’s a competitive business by its very
nature. Let’s say a team gave someone a long-term contract. What’s the player’s incentive
to compete? You must have an incentive to get out there and compete at the highest level,
or you won’t have the competitive excellence that we have in the NFL.” (Ibid.)
219 The “salary cap” is the “absolute maximum amount of Salary that each Club may pay
or be obligated to pay” its players each year. (National Football League and the NFL Players
Association, NFL Collective Bargaining Agreement, 2006-2012, p. 7.)
220 NFL Players Association, “Guaranteed Contracts in Professional Team Sports: How Does
the NFL Compare?” p. 3.

CRS-74
within the [salary] cap. There would be too much “dead money” going to players
who weren’t playing.221
Combining the salary cap with so-called guaranteed contracts possibly could
undermine a team’s ability to field a competitive team, which, in turn, might affect
the team’s revenues.
There may be a particular group of players who are especially vulnerable to
choosing to play while injured, because of the way risk is allocated between the team
and the players. Framed as a question, are the players who are less likely to have
guarantees (or to have large guarantees) included in their contracts also the players
who are more likely to be cut from the team? For some positions on a team, there are
two, three, or possibly four individuals who can play a particular position. After the
starter (the player who, generally, is the best at that position), the other players are
listed on the depth chart, in descending order, so that the individual who is number
four on the depth chart is possibly the least experienced, or least skilled, player at that
position. Players who are number three or number four on the depth chart for their
respective positions might feel pressured to play when injured in the hope of moving
up the depth chart, or not being cut from the team following the end of the season.222
Since these players, generally, are the least skilled or least experienced on the team,
it seems possible that they are less likely than players who are ahead of them on the
depth chart to have guarantees written into in their contracts. Tiki Barber, upon
retiring from the New York Giants, reportedly acknowledged that this might be a
problem: “Barber was quick to point out that he didn’t start to ponder such things
[the fact that he was no longer able to recover as quickly after games as he had in the
past] until after he was an established star. He said a player trying to make a team,
seize a role and earn a payday almost certainly isn’t thinking about his long-term
health.”223
Selected Challenges for Some Retired Players
Clearly, some former players are very successful after their careers have ended.
Among the most well-known, by virtue of their success as players and their post-NFL
careers as sports broadcasters, are, for example, Terry Bradshaw, Boomer Esiason,
Howie Long, Dan Marino, and Phil Simms.224 Other former players may, for a
variety of reasons, experience very different circumstances, as described here:
221 Nocera, “The Union That Can’t Throw Straight,” p. C1.
222 Here is another description of what might occur: “NFL depth charts are malleable. Job
security is minimal. A player goes down in a practice or a game and is quickly replaced
within the next-man-up framework. Many coaches systematically ensure that injured
players are out of view of the rest of the team, rehabilitating out of sight and, hopefully, out
of mind.” (Paul Kuharsky, “Players Sacrifice Health for Game,” Tennessean.com, Dec. 13,
2007, available at [http://ashlandcitytimes.com/apps/pbcs.dll/article?AID=/20071213/
SPORTS01/ 712130408/1001/NEWS].)
223 Ibid.
224 CBS, “CBS Sports Team,” available at [http://sportsline.com/cbssports/team]; Fox
Sports, “2007 NFL Schedule on Fox,” available at [http://msn.foxsports.com/
nfl/story/6671136].

CRS-75
While ex-NFL players can always seek employment in other professional
football leagues, such as the Canadian Football League or the Arena Football
League, salaries for players in those leagues usually pale in comparison to NFL
salaries. Thus, for most NFL players, when their NFL career ends, so too does
their professional football career. So instead of continuing a professional
football career, many ex-NFL players gravitate toward positions in coaching,
scouting, finance, sales or real estate, all of which can offer a good wage by most
standards, but typically not by NFL standards. Other ex-NFL players lack the
education, skills, or life experience to obtain continuous employment outside of
football. In short, life in the NFL may be good, but it’s usually very short, and
the vast majority of ex-NFL players are headed for lives more akin to those of
their fans than of their star teammates.225
For some retired players, then, finding gainful employment might be relatively
difficult. The lack of gainful or continuous employment could be particularly
problematic for a retiree who has chronic health problems or one or more disabilities.
In addition to financial remuneration, having a job, generally, provides access to
health insurance or some other type of health care plan or program. If a retired player
is employed by a company that does not provide medical benefits, however, it may
be difficult and costly for him to obtain his own health insurance, depending upon
the injuries he sustained as a player. As reported by a journalist, Joe Montana,
former quarterback of the San Francisco 49ers, needed health insurance upon retiring
from the NFL. The lowest estimate he received was $106,000 per year, because he
was considered to be in a high-risk group.226 Kansas City Chiefs’ guard Kyle Turley
reportedly has posed the following question: “How am I going to go to an insurance
company and say, ‘I’m overweight and have all kinds of injuries and now I’ve got to
pay for insurance for the rest of my life’?”227 According to another news article, Miki
Yaras-Davis, director of the NFLPA’s benefits department, suggested that “most
players never make enough over their careers to afford out-of-pocket costs for long-
term conditions, and very few insurance carriers will treat gridiron [football]
ailments....”228
Another aspect of the financial-medical relationship is that an individual who
has one or more chronic health problems or disabilities (as interpreted broadly),
might not be able to get or keep a job. The lack of steady employment might
decrease the probability that an individual has the resources necessary to obtain
health care.
225 Michael McCann, “NFL Retirement System Not As Bad, or Good, As Argued, SI.com,
Sept. 18, 2007, available at [http://sportsillustrated.cnn.com/2007/writers/michael_mccann/
09/18/hearings/index.html].
226 Charles Chandler, “Ex-Players Say NFL Neglects Retirees; Hall of Famers: League,
Union Leader Fall Short in Providing Benefits,” Charlotte Observer, June 4, 2007,
available at [http://www.factiva.com/].
227 Les Carpenter, “Split on NFL Union’s Effectiveness Lingers,” Washington Post, Jan. 28,
2008, p. E5.
228 Prine, “Finances Worsen Woes, Critics Say.”

CRS-76
A former player’s size — that is, the combination of his height and weight —
might lead to difficulties in finding nursing home care. Eleanor Perfetto, the wife of
former San Diego Charger Ralph Wenzel, had trouble finding a facility that would
take her husband. Wenzel suffers from Alzheimer’s-type dementia, and “ victims of
Alzheimer’s-type diseases occasionally become violent, and former football players
of his size (6 feet 2 and 215 pounds) are difficult for staff members to subdue.
‘These facilities are used to older people who are fairly decrepit — who have strokes
or blindness or use a walker, that sort of thing,’ Dr. Perfetto said.”229 While the 88
Plan will help former players with dementia and their families pay for their care, Dr.
Perfetto’s comments suggest that cost may be only part of the challenge in obtaining
appropriate health care for players with certain types of diseases.
Total and Permanent (T&P) Disability Benefit
While former players may be concerned about several of the different benefits
available to them, the T&P disability benefit seems to be particularly contentious.
At congressional hearings in 2007 and in news articles, several former players
recounted their experiences in attempting to obtain T&P benefits. The following
account about Dave Pear, a former player for the Oakland Raiders and Tampa Bay
Buccaneers, appeared in the Washington Post Magazine:
Since football, he has undergone seven spinal surgeries, including a 1984
operation to fuse a disk in his neck. He had his most recent spinal surgery last
April [2007], when doctors fused two herniated disks in his back. Not
unexpectedly, the four screws holding the disks together have left Pear with
postoperative discomfort, and at this moment he is experiencing a new throbbing
in his right hip. His doctors have said that at some point he’ll need two new
hips.... At 54, he shuffles like an ailing 80 year-old man. He suffers from
chronic fatigue that leaves him falling asleep without warning on most mornings
and afternoons....
Off and on for the past quarter-century, [Pear] has been unsuccessfully pressing
the NFL for disability benefits that he believes have been unjustly denied him by
the league’s retirement board. His monthly NFL pension is $606, but he
estimates that he often spends about $1,000 alone out-of-pocket on medication....
In 1995, he believed his working days were running out. He applied for the
league’s total and permanent disability benefit with the retirement board. The
doctor commissioned by the board to assess his condition portrayed Pear as a
man whose physical ailments left him able to do little. Presented with evidence
that included reports on Pear’s acute fatigue, the doctor said that Pear would
require a job that granted him “frequent rest breaks.” He would also need, the
doctor added, to be limited to sedentary work. Pear should not stand for lengthy
periods, should not bend and could not be expected to lift anything more than 15
pounds, the doctor wrote.... The six-man board ... rejected his claim. Three
years later, eager to put his hands on cash wherever he could find it, Pear filed
for his early retirement pension from the league at the minimum age of 45 and
started collecting $484 a month initially. The small benefit came to Pear’s
229 Alan Schwarz, “Wives United by Husbands’ Post-N.F.L. Trauma,” New York Times, Mar.
14, 2007, p. C15.

CRS-77
savings account at a severe cost: In accepting it, he sacrificed any claim to a
disability payment forever, according to the rules of the retirement board plan.230
The following is the NFLPA’s account of Pear’s efforts to obtain disability benefits:
Mr. Pear played professional football in the NFL from 1975-1980.... Mr. Pear
applied for LOD benefits in 1983. At that time, the Retirement Board was
required to determine that the player’s injury caused him to leave football before
it could grant LOD benefits. After evaluating the report of the neutral physician
who examined Mr. Pear, the three player trustees [on the Retirement Board]
wanted to award Mr. Pear the LOD benefits, but the three management trustees
refused to do so. As a result of this deadlock, the Board sent the issue to an
arbitrator, who ultimately ruled that the injury did not cause Mr. Pear to leave
football.... Mr. Pear applied for T&P benefits in 1995. The [Retirement] Plan
doctor who examined Mr. Pear determined that he could work. The [Retirement]
Board therefore concluded that Mr. Pear did not qualify for T&P disability
benefits.231
When the T&P disability benefit was established, only two categories of
benefits, “active football” and “active nonfootball,” were included. The “football
degenerative” and “inactive categories” were added in 1993. An individual does not
have to be vested to receive “active football” or “active nonfootball” T&P benefits,
but he must be vested to receive “football degenerative” and “inactive benefits.”232
The four benefit categories, including the amount of monthly payment, are as follow:
! Active football. The monthly benefit will not be less than $4,000 if
the disability or disabilities arise out of NFL football activities, or
arise while the player is an active player, and otherwise cause the
player to be totally and permanently disabled “shortly after” the
disability or disabilities first arise.233
! Active nonfootball. The monthly benefit will not be less than
$4,000 if the disability or disabilities do not result from NFL football
activities, but do arise while the player is an active player, and cause
the player to be totally and permanently disabled “shortly after” the
disabilities first arise.
! Football degenerative. The monthly benefit will not be less than
$4,000 if the disability or disabilities arise out of NFL football
activities and result in T&P disability before 15 years after the end
of the player’s last credited season.
230 Michael Leahy, “The Pain Game,” Washington Post Magazine, Feb. 3, 2008, pp. 10, 23.
231 NFL Players Association, “NFLPA White Paper,” pp. 14-15. As a result of the collective
bargaining process for the 1993 CBA, the requirement for the LOD disability benefit that
a player’s injury must have forced him to retire was eliminated from the retirement plan.
(Ibid., p. 15.)
232 Letter from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, p. 5.
233 See Table 4, note o. for an explanation of “shortly after.”

CRS-78
! Inactive. The monthly benefit will not be less than $1,500 ($1,750
for applications received on or after April 1, 2007) if the T&P
disability arises from other than NFL football activities while the
player is a vested inactive player, or the disability or disabilities
arise(s) out of NFL football activities and result(s) in total and
permanent disability 15 or more years after the end of the player’s
last credited season, whichever is later.234
Individuals who receive active T&P benefits in the “active football,” “active
nonfootball,” or “football degenerative” categories automatically qualify for NFL
Player Supplemental Disability Plan benefits.235 Table 12 shows the amounts of
payments for each category of T&P benefit. The NFL and the NFLPA announced on
February 29, 2008, that “the minimum benefit post-career” for “non-football ‘total
and permanent’ disability” had doubled from “$20,000 to $40,000 per year for retired
players who become disabled unrelated to football,” which, apparently, is a reference
to “inactive” benefits.236 However, because details involving this change are not
available yet, Table 12 does not incorporate this change.
Table 12. Total and Permanent Disability Payments by Category
Supplemental
T&P Disability
Category
Disability Plan
Total
Benefit Amount
Benefit Amount
Active Football
Monthly
$4,000
$14,670
$18,670
Annually
$48,000
$176,040
$224,040
Active
Nonfootball
Monthly
$4,000
$7,167
$11,167
Annually
$48,000
$86,004
$134,004
Football
Degenerative
Monthly
$4,000
$5,167
$9,167
Annually
$48,000
$62,004
$110,004
234 Bert Bell/Pete Rozelle NFL Player Retirement Plan, p. 20.
235 Bert Bell/Pete Rozelle NFL Player Retirement Plan, Summary Plan Description, Apr.
2005, p. 15.
236 National Football League and NFL Players Association, “NFL and NFL Players
Association Expand Disability Benefits Program for Retired Players,” p. 1.

CRS-79
Supplemental
T&P Disability
Category
Disability Plan
Total
Benefit Amount
Benefit Amount
Inactive

Monthly
$1,500a
0
$1,500
$1,750b
0
$1,750
Annually
$18,000a
0
$18,000
$21,000b
0
$21,000
Sources: National Football League and NFL Players Association, NFL Collective Bargaining
Agreement, 2006-2012, Mar. 8, 2006; Bert Bell/Pete Rozelle NFL Player Retirement Plan, Apr. 1,
2001.
a. This amount is for players who applied for T&P benefits prior to Apr. 1, 2007.
b. This amount is for players who applied on or apply after Apr. 1, 2007 for T&P benefits.
An active player who sustains an injury that results in a T&P disability receives
the largest annual payment, $224,040. Comparing the latter three categories with this
category (“active football”) shows that the “active nonfootball” total annual amount
equates to 60% of the “active football” benefit total annual amount; “football
degenerative” equates to 49%; and “inactive” equates to 8% ($18,000) and 9%
($21,000). The size of the payment for the “inactive” category, when compared to
the size of the payments for the other three categories, and the threshold for
distinguishing between a “degenerative football” disability and an “inactive”
disability (which is discussed below), might contribute to the contentious nature of
disagreements between retirees, on the one hand, and the NFL, the NFL Players
Association, and the Plan Office, on the other hand.
As Table 12 shows, the benefit amount decreases if the disability is not related
to football, and whether a disability is related to football is determined by the amount
of time that has passed since retirement from the NFL. In the following explanation
of how T&P benefits are structured, the NFLPA essentially confirms that this is the
methodology for determining the size of benefit for each category:

The criteria for all of these T&P benefits [the four categories] were forged in
collective bargaining. Which category applies in a specific case generally
depends on (1) the cause of the disability and (2) the length of time between a
player’s NFL career and his inability to work. In the view of the NFLPA, it is
appropriate for the benefit to be greater where NFL football was the cause and
it is appropriate that the payment amount may depend in part on the length of
time between the player’s NFL career and his inability to work.237
This explanation raises a few questions. For example, does scholarly literature
indicate that total and permanent disabilities caused by injuries peculiar to playing
professional football manifest themselves within a certain time frame? Specifically,
is the time frame selected by the NFL and the NFLPA — 15 years — supported by
237 Letter from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, p. 18.

CRS-80
scholarly literature? Additionally, do some types of disabilities appear later than
others?
The threshold (that is, time frame) for determining whether a player’s disability
can be classified as “football degenerative” instead of “inactive” was changed in
2006 for applications received on or after September 1, 2006. Table 13 shows the
relevant language prior to the 2006 amendment — which still applies to applications
received prior to September 1, 2006 — and the current (post-amendment) language,
which applies to applications received on or after September 1, 2006. The key
difference between the two versions, as shown below, is that the time threshold,
which is used to determine whether a player who is otherwise eligible for T&P
benefits receives the “football degenerative” benefit, has changed.
Table 13. Selected Criteria for Football Degenerative and
Inactive Categories
Retirement PlanVerison
Football Degenerative
Inactive
Prior to 2006 Amendmenta
“(c)The monthly benefit
“(d) Inactive: monthly
will not be less than
benefit will not be less
$4,000 if the disability or
than $1,500 if the T&P
disabilities arise out of
disability arises from other
NFL football activities and
than NFL football
results in T&P disability
activities while the player
before age 45 or 12 years
is a vested inactive player,
after the end of the
or the disability or
player’s last credited
disabilities arises out of
season, whichever is
NFL football activities and
later.”
results in total and
permanent disability after
age 45 or 12 years after
the end of the player’s last
credited season, whichever
is later.”
2006 Amendmentb
“(c) Football degenerative:
“(d) Inactive: monthly
monthly benefit will not
benefit will not be less
be less than $4,000 if the
than $1,500 [or $1,750 for
disability or disabilities
individuals who applied
arise out of NFL football
on or after April 1, 2007]
activities and results in
if the T&P disability arises
T&P disability before 15
from other than NFL
years after the end of the
football activities while
player’s last credited
the player is a vested
season.”
inactive player, or the
disability or disabilities
arises out of NFL football
activities and results in
total and permanent
disability 15 or more years
after the end of the
player’s last credited

CRS-81
Retirement PlanVerison
Football Degenerative
Inactive
season, whichever is
later.”
Sources: Bert Bell/Pete Rozelle NFL Player Retirement Plan, Apr. 1, 2001; “Bert Bell/Pete Rozelle
NFL Player Retirement Plan, Amendment,” amendment to Sec. 5.1(c), signed Sept. 12, 2006; “Bert
Bell/Pete Rozelle NFL Player Retirement Plan, Amendment,” amendment to Sec. 5.1(d), signed Oct.
4, 2006.
a. The language in this row applies to applications received prior to Sept. 1, 2006.
b. The language in this row applies to applications received on or after Sept. 1, 2006.
Table 14 shows how the change in the threshold will affect players, depending
upon the age at which they retire, who file for T&P disability benefits on or after
September 1, 2006.
Table 14. Effect of 15-Year Threshold on Eligibility for “Football
Degenerative” Benefits
Latest Age at Which Player Can Receive “Football
Age at Which Player
Degenerative” Benefits
Retires
Prior to 2006 Amendment
2006 Amendment
23a
45
38
25
45
40
30
45
45
35
47
50
40
52
55
45
57
60
50
62
65
Sources: Table developed by the author using the following information: Bert Bell/Pete Rozelle NFL
Player Retirement Plan, Apr. 1, 2001; “Bert Bell/Pete Rozelle NFL Player Retirement Plan,
Amendment,” amendment to Sec. 5.1(c), signed Sept. 12, 2006; “Bert Bell/Pete Rozelle NFL Player
Retirement Plan, Amendment,” amendment to Sec. 5.1(d), signed Oct. 4, 2006.
a. This is most likely the youngest age at which a player could retire and be vested. A player must
have three credited seasons to be vested, and it is assumed that no one younger than 20 enters
the NFL. Pursuant to the CBA, an individual shall not be eligible for the draft “until three
regular NFL seasons have begun and ended following either his graduation from high school or
graduation of the class with which he entered high school, whichever is earlier. For example,
if a player graduated from high school in December 2006, he would not otherwise be eligible
for selection, until the 2010 Draft.” (National Football League and NFL Players Association,
NFL Collective Bargaining Agreement, 2006-2012, Mar. 8, 2006, p. 46.)

CRS-82
This table shows that the change in criteria will affect differently players
younger than age 30 and players older than age 30 at the time of retirement. For
players who are younger than 30 when they retire, their disabilities, if any, will need
to surface at a younger age than under the previous criteria for them to be eligible for
the “football degenerative” benefit. Players who retire at age 31 or older will have
an additional three years, compared to the previous criteria, in which their disabilities
may surface for them to be eligible for the “football degenerative” category. The
implications of this change in criteria for players who retire before they reach age 30
are unknown. As noted above, the length of an average career is 3½ seasons, so a
significant number of players might retire before age 30. Accordingly, players who
have relatively short careers probably sustain fewer injuries than their peers who
play for 10 or 15 years.
Applications for disability benefits are initially considered by the Disability
Initial Claims Committee (DICC). Subsequently, an applicant may have an
application reconsidered by the Retirement Board. (29 CFR §2560.503-1(h)(3)(ii)
and (4) require a disability plan to have a mechanism for an applicant to appeal an
adverse benefit determination, and stipulate that neither the individual who made the
adverse determination, nor anyone subordinate to this individual, can hear the
appeal.) On its review, the Board is not bound by the evidence presented to the
DICC or its findings, but rather has broad discretion as to what it may take into
account, including evidence not previously presented. Decisions of the Board may
be appealed to federal courts.
Overall, from July 1, 1993, through June 26, 2007, 1,052 individuals applied for
LOD or T&P disability benefits: 428 applications were approved; 576 were denied;
and 48 are pending. The approval rate, which does not include the cases that are
pending, is 42%.238 The following series of statements shows the status of
applications at each step of the process.
! 1,052 applications submitted for disability benefits.
! 358 (34%) applications approved.
! 675 (64%) applications denied.
! 19 (2%) applications are pending.
! 223 (33% of 675) applications denied at the initial stage were
appealed.
! 69 (31%) approved on appeal.
! 132 (60%) denied on appeal.
! 22 (10%) appeals are pending.
! 32 (24% of 132) applicants whose appeals were denied filed a
lawsuit.
! 1 (3%) lawsuit resulted in a reversal of the Retirement
Board’s decision.
238 Letter from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, pp. 9-10.

CRS-83
! 24 (75%) lawsuits resulted in the Retirement Board’s
decisions being upheld.
! 7 (22%) lawsuits are pending.239
This tally shows that of the cases it decided, the DICC’s approval rate was a
little over 34%. The Retirement Board’s approval rate of the cases it reviewed
following DICC consideration was similar, at 31%. The opportunity for Retirement
Board review resulted in a greater overall approval rate of about 42% of applications
filed. On the other hand, were the Retirement Board alone to have considered
applications, it is not certain that the overall approval rate would have been lower
than 42%, or if the approval rate might be equal to or even exceeding the 42% rate.

The reasons applications are denied, which are not publicly available, might
shed some light on why applicants decide not to appeal, or otherwise challenge,
adverse decisions. Some applicants may have missed a deadline, not been able to
provide satisfactory documentation to the Disability Initial Claims Committee
(DICC), or applied for T&P benefits while already receiving a retirement plan
pension (a player who is receiving a pension is not eligible for disability benefits).
Information on the reasons for denial possibly could be useful in identifying
processes, policies, or guidelines that could be improved. Information on the reasons
for denial, particularly if made available to former players (if not to the public as
well), could provide some transparency and possibly facilitate accountability.
Table 15 shows how many former players receive, or have received, T&P
benefits as of a single day. The latter group includes players who, upon reaching age
55, had their T&P benefits automatically converted to pension payments, with no
reduction in the amount of money they receive. The data in Table 15 are current as
of a single day, October 23, 2007.
Table 15. Number of Players Who Are Receiving or Have
Received T&P Benefits, as of October 23, 2007
Number and
Number and
Percentage of Players
T&P
Percentage of Players
Who Are Age 55 or
Disability
Receiving T&P
Total
Older and Who
Category
Benefits as of October
Previously Received
23, 2007a
T&P Benefitsb
Active
6
2
8
Football
(4%)
(3%)
(4%)
Active
9
3
12
Nonfootball
(6%)
(4%)
(5%)
Football
91
21
112
Degenerative
(60%)
(30%)
(50%)
239 Ibid.

CRS-84
Number and
Number and
Percentage of Players
T&P
Percentage of Players
Who Are Age 55 or
Disability
Receiving T&P
Total
Older and Who
Category
Benefits as of October
Previously Received
23, 2007a
T&P Benefitsb
Inactive
48
44
92
(31%)
(63%)
(41%)
Total
154
70
224
Source: Letter from Eugene Upshaw, Executive Director, NFL Players Association, to Reps. John
Conyers, Jr., Lamar S. Smith, Linda T. Sanchez, and Christopher B. Cannon, Nov. 5, 2007, pp. 6-7.
a. This column includes former players who are age 54 or younger.
b. Disability benefits are converted to retirement benefits at age 55. The amount of the benefit does
not change when the conversion occurs.
According to Table 15, eight players receive the highest payment available
($224,040). Moving on to “active nonfootball,” 12 former players receive payments
that equate to 60% of the highest payment; 112 players in the “football degenerative”
category receive payments that are 49% of the highest amount; and 92 players in
“inactive” category receive 8% or 9% of the highest amount. Comparing the total
number of players who are younger than age 55 with the total number of players who
are age 55 or older shows that more than twice as many players receiving T&P
benefits are under age 55. Table 15 also shows that the percentages of players
receiving “active football” and “active nonfootball” benefits are similar. A
significant difference between the two age groups is evident in the percentages of
players who receive “football degenerative” and “inactive” benefits: 60% of the
players younger than 55 receive “football degenerative” benefits while only 30% of
players older than 55 receive the same type of benefit. The percentages are reversed
for “inactive benefits.” It is not clear why this difference exists. It may be due, for
example, to changes in the benefit plan over the years. As noted above, the benefit
plan initially included only two types of T&P benefits.
A comparison between active players and former players shows that only 9%
(active football and active nonfootball) of the T&P disabilities occurred when an
individual was in the NFL. Conversely, the data suggest that most T&P disabilities
— 91% — surface after players have retired and been out of the NFL more than six
months.
The league and the players association have taken steps designed to improve the
disability application process. In December 2007, the NFL announced that the
organizations had agreed on a series of improvements involving disability benefits,
including providing prescription drug cards to retired players that will permit them
to buy prescription medications at a discount.240 The changes are as follow:
240 National Football League, “Improvements Made to Disability Plan Procedures,” news
release, Dec. 12, 2007.

CRS-85
1. Medical Director — The plan will retain a medical director to consult with the
two-person initial claims committee and, as needed, with the retirement board to
assist in resolving claims. It is expected that this will reduce the number of
initial denials at the claims committee level, expediting both initial approvals and
the processing of appeals. In addition, the medical director can help ensure that
standards are consistently applied, that reports are prepared in a timely basis, and
otherwise monitor the performance of neutral physicians.
2. Physician Panels — The plan will establish a series of physician “panels” or
“teams,” consisting of doctors with experience in orthopedic and other practices.
These teams will be located in areas where there is the largest concentration of
retired players, including in Arizona, California, Florida and Texas, as well as
in other major metropolitan areas. This change will reduce the trips required of
people needing to be examined by doctors in different specialties.
3. Claims Specialist — The plan will provide a specialist to receive calls from
applicants via a toll-free number. This specialist will assist in preparing
applications and advise applicants on the information that is required. The
completed application will be sent to the applicant for review, verification and
signature. The 45-day review period will begin once the signed application is
returned. This service will make it more likely that applications are completed
correctly the first time and thus reduce the processing time.
4. Expedited Email Appeals — The retirement board will, whenever possible,
decide appeals via email ballots. This will allow for faster decisions on many
appeals and will avoid requiring applicants to wait for the next scheduled
meeting of the retirement board.
5. Extending Review Period — The plan will reduce the number and frequency
of continuation reviews for those applicants receiving total and permanent
disability benefits by extending the current three-year maximum to at least five
years. Any three trustees may require a continuation review more frequently,
although not more frequently than annually, if they decide there is reason to do
so.241
Furthermore, the NFL and the NFLPA have agreed that any eligible former player
who is receiving Social Security disability benefits will be granted disability benefits
automatically and will not have to be examined by a retirement plan doctor.242 Other
changes to T&P disability benefits may be found in Table 4.
Conducting a program evaluation of the T&P disability benefit plan, which
would include an examination of the outcomes and unintended consequences, if any,
of these changes, could aid in establishing and maintaining an efficient, effective, and
responsive disability plan and application process. Sharing the results of the study
with all interested parties, including, for example, the NFL, NFLPA, former players,
and active players, could promote transparency and accountability.
241 Ibid.
242 NFL Players Association, “NFLPA White Paper,” n.d., pp. 5-6.

CRS-86
Is There a Subset of Former Players with Exceptional Needs?
For a variety of reasons, it seems possible that a former player’s financial and
medical needs might be related to his age. While the usual effects of the aging
process can affect a retiree’s health and employment situation, there may be
additional factors that could affect older retirees. Over the years, improvements and
advances have taken place in these areas: playing rules,243 equipment, and playing
surfaces; medical knowledge, procedures, and technologies; and benefits. Therefore,
it seems likely that individuals who played 20, 30, and 40 years ago might not have
been protected as well as current players; might have received medical care that,
while the best available at the time, was not as effective or successful as the care
available today; and are not eligible for all of the benefits available to current players.
Thus, older players might be a subset with, for the reasons stated here, exceptional
financial and medical needs, and their needs exceed the benefits available to them.
Playing rules, protective equipment, and playing surfaces have evolved over the
years. For example, until it was prohibited in 1977, a player could use the “head
slap” (that is, slap another player on the side of his helmet) to disorient another
player.244 As for protective equipment, the helmet, which, in addition to shoulder
pads, is the only piece of protective equipment players are required to wear, has
evolved from wool stocking caps (1800s) and leather (1920s) to fiber shell (1934)
and plastic (1943-present).245 Additionally, it was not until the early 1970s that the
first safety requirements for football helmets were instituted.246 Regarding the
243 Over the years, the NFL has forbade a number of techniques used by players against one
another that were deemed dangerous, such as “clothes lining,” “spearing,” and “cut
blocking.” See National Football League, “Summary of Penalties,” available at
[http://www.nfl.com/rulebook/penaltysummaries].
244 U.S. Congress, House Committee on the Judiciary, Subcommittee on Commercial and
Administrative Law, “The National Football League’s System for Compensating Retired
Players: An Uneven Playing Field? statement of Cy Smith, unpublished hearing, 110th
Cong., 1st sess., June 26, 2007, p. 4.
245 Alan Schwarz, “Far From Grandpa’s Leather, Helmet Absorbs Shock a New Way,” New
York Times, Oct. 27, 2007, p. A10.
246 Ibid. The organization that developed the test standards for football helmets, the National
Operating Committee on Standards for Athletic Equipment (NOCSAE), was formed in
1969. NOCSAE comprises “representatives from a number of groups which have an interest
in athletic equipment. These include manufacturers, reconditioners, athletic trainers,
coaches, equipment managers, sports medicine and consumer organizations.” (National
Operating Committee on Standards for Athletic Equipment, “About NOCSAE,” available
at [http://www.nocsae.org/about/index.html].) Improvements in helmet technology
continue. A new helmet, the Xenith X1, has been developed that “features 18 black,
thermoplastic shock absorbers filled with air that ... can accept a wide range of forces and
still moderate the sudden jarring of the head that causes concussion. Morever, laboratory
tests have shown that the disks can withstand hundreds of impacts without any notable
degradation in performance, a longtime drawback of helmets’ traditional foam. Dr. Robert
Cantu of Brigham and Women’s Hospital in Boston, one of the nation’s leading experts in
concussion management, reportedly called it ‘the greatest advance in helmet design in at
(continued...)

CRS-87
playing surface in NFL stadiums, the type or types of artificial turf used in the past
were found to contribute to players’ injuries. A 1974 study commissioned by the
NFL reportedly found that “natural grass was safer to play on than the artificial
surfaces then being produced for football.”247 A 1985 Sports Illustrated article
reported that “[t]he NFLPA found that the average turf injury took longer to heal, that
the number of players placed on injured reserve increased by a third and that the
number of missed games doubled when the injuries occurred on turf.”248
It seems likely, because of ongoing medical research and advances in medical
care, procedures, and technologies, that players today receive better medical care than
individuals received in the past. The following excerpt from an article summarizes
some of the advances that have occurred since the early 1980s:
Arthroscopy. Doctors can now repair knees, shoulders and other joints without
making huge incisions. Instead, they use tiny tools snaked via tubes under the
skin to perform surgery. In the early 1980s, reconstructing a knee ligament could
require a two-foot long incision and a two-hour procedure. Now it may only take
a few half-inch ones and only 40 minutes to complete.
Imaging. Players might get daily X-rays to assess the progress of a broken bone.
Steelers linebacker Earl Holmes was hurt in the second quarter of one playoff
game; doctors had magnetic resonance imaging pictures of his knee by the third
quarter.
Year-round training. Players now get nutrition, sports psychology and strength-
training advice designed specifically around their injuries and train year-round
to prevent them.249
In the following excerpt from a news article, a fullback for the Tennessee Titans
plans to rely on improvements the field of medicine for treating his injuries, and
notes a difference between his father’s experience and his experience with knee
surgery:
246 (...continued)
least 30 years’.” (Schwarz, “Far From Grandpa’s Leather, Helmet Absorbs Shock a New
Way,” p. A1.)
247 John Underwood, “Just an Awful Toll,” Sports Illustrated, Aug. 12, 1985, available at
[http://www.lexisnexis.com/], p. 48.
248 Ibid. As of 2007, 19 NFL stadiums had grass playing fields, and the remainder had
artificial turf, though it seems likely that, because of improvements over the years, the
artificial turf installed in stadiums in the 21st century is better than the products that were
installed 20 and 30 years ago. (Stadiums of the NFL, “Comparisons,” available at
[http://www.stadiumsofnfl.com/ comparisons.htm].) According to this source, among the
stadiums that have artificial turf, 11 have had FieldTurf installed, and one stadium has a
SportExe product. Information about these companies and their products is available at
[http://www.fieldturf.com/index.cfm] and [http://www.sportexe.com/], respectively. These
companies’ websites include descriptions of how their products are designed and
constructed.
249 Vergano, “NFL Doctors, Players Face Off Over Painful Choices.”

CRS-88
... Casey Cramer said he’s thought about the effects of poundings, but he’s
placing a large degree of faith in medical advances. He remembers how arduous
it was for his dad, a former player, to recover from knee surgery 30 years ago.
He also remembers being able to walk within hours of his own knee operation.
“I feel like the science is getting a lot better,” Cramer said. “Surgeries,
medicines, and all of those things have improved over the years. I’ve said
jokingly that I’m banking on science to fix my body afterwards, [but] I feel like
20 or 30 years from now, science will be a lot better.”250
Former players who did not have the benefit of the rules, protective equipment,
and medical procedures and technologies that are available to today’s players also
have fewer benefits available to them. As shown in Table 16, individuals who
played in the NFL prior to 1982 have eight benefits available to them; current players
have 14 benefits. While this comparison shows that the number of benefits has
increased over the years, it also shows how many and which benefits are not, or were
not, available to some former players. For the reasons described above, however,
older retirees might have the greatest medical and financial needs.
The NFL and the NFLPA announced, on February 29, 2008, that five additional
benefits had been, or would be, established for former players: a joint replacement
surgery and rehabilitation program, a screening program for cardiovascular health
and obesity, a prostate cancer screening program, discounted rates for assisted living
facilities managed by three companies, and a prescription drug card.251 Additional
information regarding these benefits is provided above, but because, for example,
eligibility criteria, implementation dates, and other details have not been publicized
yet, these benefits are not included in Table 16.
At least a few benefits were made retroactive when established or at some later
date, which means that a benefit is available to all players, regardless of which year
or years they played in the NFL. The 88 Plan is an example of a benefit that is
retroactive, and, in 1993, the players known as “pre-59ers” were added to the Bert
Bell Pension Plan. The nature of some benefits, however, seems to have precluded
making them retroactive. Examples include the Second Career Savings Plan and
severance pay.
250 Ibid.
251 National Football League and NFL Players Association, “NFL and NFL Players
Association Expand Disability Benefits Program for Retired Players,” Feb. 29, 2008, pp. 2-
3.

CRS-89
Table 16. Benefits Available to Players
If an Individual Played in the
NFL During the Following
The Benefits Available to Him Are:a
Period:
Not later than 1981
88 Plan
Cardiovascular Health Program
Death Benefits
Line of Duty Disability
NFL Player Joint Replacement Benefit Plan
Retirement Benefits
Total and Permanent Disability Benefits
Workers’ Compensation
1982-1992
88 Plan
Cardiovascular Health Program
Death Benefits
Line of Duty Disability
NFL Player Joint Replacement Benefit Plan
Retirement Benefits
Severance Payb
Total and Permanent Disability Benefits
Workers’ Compensation
1993-1997
88 Plan
Cardiovascular Health Program
Death Benefits
Line of Duty Disability
NFL Player Joint Replacement Benefit Plan
Retiree Medicalb
Retirement Benefits
Second Career Savings Planb
Severance Pay
Supplemental Disability Planb
Total and Permanent Disability Benefits
Workers’ Compensation
1998-2003
88 Plan
Annuity Programb
Cardiovascular Health Program
Death Benefits
Line of Duty Disability
NFL Player Joint Replacement Benefit Plan
Retiree Medical
Retirement Benefits
Second Career Savings Plan
Severance Pay
Supplemental Disability Plan
Total and Permanent Disability Benefits
Workers’ Compensation
2004-Present
88 Plan
Annuity Program
Cardiovascular Health Programb

CRS-90
If an Individual Played in the
NFL During the Following
The Benefits Available to Him Are:a
Period:
Death Benefits
Health Reimbursement Account Planb
Line of Duty Disability
NFL Player Joint Replacement Benefit Planb
Retiree Medical
Retirement Benefits
Second Career Savings Plan
Severance Pay
Supplemental Disability Plan
Total and Permanent Disability Benefits
Workers’ Compensation
Source: Letter from Eugene Upshaw, Executive Director, NFL Players Association, to Reps. John
Conyers, Jr., Lamar S. Smith, Linda T. Sanchez, and Christopher B. Cannon, Nov. 5, 2007, p. 20.
a. A player has to meet the eligibility criteria to receive a benefit.
b. The benefit was established during this time period. If the benefit is retroactive, it appears in the
list for previous time period(s).
In some cases, it is possible that an individual made one or more decisions that,
ultimately, resulted in adverse consequences. For example, players are, or have been,
able to choose when and how they receive certain benefit payments, but the
consequences of some choices can negatively affect the individual’s financial status.
Examples of such choices are the following:
! Prior to the 1993 CBA, a player could choose to begin receiving his
pension at age 45, which is 10 years earlier than the NFL’s normal
retirement age of 55. By electing to begin his pension 10 years
early, the “age-55 benefit is actuarially reduced by more than 50%
in this situation, since [the former player] will receive [his] pension
for ten more years.” This option is no longer available, except to
former players who played in at least one season prior to 1993.
Despite being warned about the consequences of opting for an early
pension, players continue to do so.252
! Some former players chose a “Social Security Adjustment” form of
benefit, “in which the majority of their retirement benefit is paid
prior to age 62, with only a token benefit starting at age 62.”
Electing this option decreases a player’s retirement benefits when he
252 NFL Players Association, “NFLPA White Paper,” pp. 22-23. As noted above, players
who took their NFL pension early “will be offered a new one-time opportunity” in 2008 to
apply for T&P disability benefits. (National Football League and NFL Players Association,
“NFL and NFL Players Association, “NFL and NFL Players Association Expand Disability
Benefits Program for Retired Players,” p. 1.)

CRS-91
reaches age 62.253 “For example, instead of receiving $271 a month
for life beginning at age 45, a player could use this ... option to
receive about $384 a month from age 45 up to age 72, and only $50
a month thereafter.”254
! Beginning with the 1977 CBA, a player was able to choose a lump
sum “early payment benefit” (EPB), which was equal to 25% of his
pension, one year after retiring from the NFL. As a result, all
pension payments he would have received later were reduced by
25%.255
The 1993 CBA eliminated all three of these options for players who entered the NFL
in 1993 or later. According to the plan counsel for the retirement plan, under federal
law, these options remain available to players who earned a credited season before
1993.256
In congressional testimony, the plan counsel showed, through the following
account of an unnamed former player’s circumstances, how a series of decisions can
adversely affect an individual’s finances:
[He] complains that his retirement benefit is too small, but doesn’t mention that
he 1) chose to retire at age 45 with a 45% actuarial reduction, 2) elected the
social security option providing the lion’s share of his pension up front, 3) knew
that he would only receive a token pension when he became 62, and 4) was
ordered by a divorce court to share his pension with his ex-wife.257
As reported by a journalist, Leroy Kelly, a former running back for the Cleveland
Browns, requested that his pension begin at age 45. Consequently, his $800 monthly
payment decreased to $112 when he began drawing Social Security payments.258
Another former player, Joe DeLamielleure, also chose to take his pension early.
Faced with a family financial crisis, the former guard for the Cleveland Browns and
Buffalo Bills opted for an early pension, which resulted in a monthly payment of
$992; if he had waited until he reached age 55 (normal retirement age for players),
he would have received $2,200 per month.259 These examples show that a player’s
253 Ibid., p. 23.
254 U.S. Congress, House Committee on the Judiciary, Subcommittee on Commercial and
Administrative Law, “The National Football League’s System for Compensating Retired
Players: An Uneven Playing Field?” statement of Douglas W. Ell, unpublished hearing,
110th Cong., 1st sess., June 26, 2007, p. 6.
255 Ibid.
256 Ibid., p. 8.
257 Ibid., p. 18.
258 Charles Chandler, “Ex-Players Say NFL Neglects Retirees; Hall of Famers: League,
Union Leader Fall Short in Providing Benefits,” Charlotte Observer, June 4, 2007.
259 Ibid.

CRS-92
decisions and personal circumstances (for example, getting a divorce) also might
affect the level of benefits that he receives.
What Is Known about Injuries and
Possible Long-Term Consequences?
Considering the frequency and extent of football injuries, the potential risk of
certain medical conditions (such as excessive weight, cardiovascular disease, and
sleep apnea), and the possibility that injuries and medical conditions might have
long-term consequences, how much is known about these subjects? Specifically,
what do the NFL and the NFLPA know; what are their sources of information; and
how do they use the information? The league and the players association have
conducted or sponsored, separately as well as jointly, studies and articles on subjects
related to players’ health, and the NFL has several studies planned or in progress.260
However, as demonstrated by the following examination of MTBI research,
contradictions among the findings of different studies contribute to the challenge of
understanding injuries, medical conditions, and their possible long-term
consequences.
The following four subsections present scholarly research on the long-term
effects of concussions, susceptibility to additional MTBI, and chronic traumatic
encephalopathy (CTE). It is beyond the scope of this report to assess the merits and
drawbacks of scholarly articles in the field of neurology. Excerpts from articles and
peer reviews of articles are included to show the findings and the nature or extent of
disagreement among authors. Some disagreements may flow from methodological
differences, such as the type of survey instrument used (for example, telephone, mail,
or personal interview) or the method used to select study participants.
Several of the articles included here were written by members of the NFL’s
MTBI Committee. The other articles were written by professionals in the field of
neurology or related fields who are not affiliated with the NFL or the NFLPA.
Members of the MTBI Committee have published 14 articles in the journal
Neurosurgery.261 Within each heading, articles are presented in the order in which
they were published. In Neurosurgery, peer reviewers’ comments on particular
articles are published following the articles, and excerpts from each peer reviewer’s
comments are included with the applicable article.
Studies on Possible Long-Term Effects of MTBI. Although members
of the MTBI Committee did not publish an article focused exclusively on the long-
term effects of concussions, they did address the issue in an article on
neuropsychological testing. In the sixth article of the 14-article series, committee
members suggested that multiple MTBIs would not permanently affect an individual.
Pellman, et al., wrote the following:
260 A list of these studies and articles is found in Appendix B.
261 These articles are included in Appendix B.

CRS-93
The strong correlation between the results of clinical and neuropsychological
evaluations also provides supportive evidence for the position that there is no
evidence in this study of widespread permanent or cumulative effects of single
or multiple MTBIs in professional football players. In other words, the results
of this present study support the authors’ previous work, which indicated that
there was no evidence of worsening injury or chronic cumulative effects of
multiple MTBIs in NFL players.262
NFL players did not demonstrate evidence of neurocognitive decline after
multiple (three or more) MTBIs or in those players out 7+ days [from the date of
the concussion]. The data show that MTBI in this population is characterized by
a rapid return of neuropsoychological function in the days after injury.263
A theme among peer reviewers’ comments was that the finding — the evidence
does not support a link between single or multiple MTBIs and long-term effects —
was questionable. The following are excerpts from peer reviewers’ comments:
In addition, I do not believe that this study, with correlation between clinical and
neuropsychological evaluation, proves that there are no widespread permanent
or cumulative effects of single or multiple MTBI in NFL players. I think that it
is premature to conclude that there are no long-term consequences of MTBI in
football while players are still active, for many reasons.264
... these results should be interpreted with caution. Further follow-up of players
sustaining MTBI is needed to better determine the cumulative effect of multiple
concussions.265
The authors possess a remarkable data set. My strongest impression after
reading the article was that the data set was so important that it deserved
additional analysis and that a good place to start would be to remove the outliers
and see the results.266
It is specifically recommended that the statement that there are no widespread
permanent or cumulative effects of single or multiple MTBIs in professional
football players be softened somewhat.267
262 Elliot J. Pellman, et al., “Concussion in Professional Football: Neuropsychological
Testing — Part 6,” Neurosurgery, vol. 55, no. 6, Dec. 2004, p. 1299.
263 Ibid., p. 1290. As quoted in a news article in the Wall Street Journal, Dr. Pellman said
that he has studied players who had multiple concussions and that “‘they had all returned
to normal. Does that mean there may or may not be problems 10 to 15 years from now? I
don’t know, but the early objective data say no.’ Dr. Pellman says the NFL hasn’t studied
former players’ health because they are no longer employees and are geographically
scattered.” (Ellen E. Schultz, “A Hobbled Star Battles the NFL,” p. A2.)
264 Elliot J. Pellman, et al., “Concussion in Professional Football: Neuropsychological
Testing — Part 6,” see comments by Julian E. Bailes, p. 1304.
265 Ibid., see comments by Daniel F. Kelly, p. 1304.
266 Ibid., see comments by Joseph Bleiberg, p. 1304.
267 Ibid., see comments by Joseph C. Maroon, p. 1305.

CRS-94
Given the methods and statistical design used, it is difficult to understand how
they can comment that ‘The strong correlation between the results of clinical and
neuropsychological evaluations also provides supportive evidence for the
position that there is no evidence in this study of widespread permanent or
cumulative effects of single or multiple MTBIs in professional football players.’
They only studied the acute neuropsychological effects of single and repeat
concussion, and the data presented tell us nothing about potential ‘permanent’
or long-term complications. The authors cannot assume that there could not be
chronic effects, especially since they have only looked at a brief window of
time.268
A study carried out by physicians who are not affiliated with the NFL and led
by the research director of the Center for the Study of Retired Athletes (CSRA),
Kevin M. Guskiewicz, focused specifically on the long-term effects of concussions
in former NFL players. As the following excerpt shows, Gukiewicz, et al., reached
a different conclusion than did Pellman, et al., regarding possible long-term
consequences of MTBIs.
These data describe a significant association between recurrent concussion and
MCI, as well as with self-reported memory impairments confirmed by a spouse
or close relative. Retired professional football players with three or more
concussions were twice as likely to be diagnosed with MCI as those with one or
two previous concussions, and five times more likely than those with no previous
concussions. This trend continued with respect to self-reported significant
memory problems. These findings suggest that the clinical features of dementia-
related syndromes ... may be initiated by repetitive cerebral concussions.269
Another result of the survey conducted by Guskiewicz, et al., involved the prevalence
of concussions among retired NFL players. Among former players who participated
in the study, 60.8% reported having had at least one concussion during their NFL
careers, and 24% reported sustaining three or more concussions.270
Peer reviewers’ comments on Guskiewicz, et al., noted, among other points, that
relying on self-reported information might affect the accuracy of the data collected.
Several peer reviewers also commented on the value and possible implications of the
study.
Like all retrospective studies that rely upon self-reported medical histories and
health problems, this one is subject to bias in the accuracy with which problems
were recalled and reported. Nevertheless, these results are of considerable
interest. The authors make appropriate recommendations for further prospective
studies....271
268 Ibid., see comments by Kevin M. Guskiewicz, p. 1305.
269 Kevin M. Guskiewicz, et al., “Association Between Recurrent Concussion and Late-Life
Cognitive Impairment in Retired Professional Football Players,” Neurosurgery, vol. 57, no.
4, Oct. 2005, p. 723.
270 Ibid., p. 721.
271 Ibid., see comments by Alex B. Valadka, p. 725.

CRS-95
Studies such as this have the potential to provide important information
[regarding the possibility of neurologic impairment surfacing after a player has
retired]. Unfortunately, this particular study is confounded by a critical design
flaw of relying on retired athletes to accurately recall events from decades earlier
and relating those events to their current memory problems.272
This study has important and far-reaching implications. To my knowledge, this
is one of few studies to show a positive association between repetitive
concussion and long-term cognitive impairment and Alzheimer’s disease.273
This is an interesting paper that poses an intriguing hypothesis regarding the
consequences of recurrent concussion, not only to create short-term problems,
but also to accelerate the decline of cognitive function in later years. While
tantalizing, the findings are soft. The data are derived from a questionnaire
administered to a group that may have substantial bias, especially considering the
recent reports and concerns expressed by physicians and the media.274
This is an extremely valuable contribution. Most concussion studies focus on the
days and weeks following the injury with the implicit assumption that recovery
to preinjury levels is the end of the issue. The present paper provides strong
suggestion that some residua of a concussion may not become manifest until
decades after the injury.... The authors are to be commended for clearly stating
the limitations of their retrospective self-report experimental design. However,
the “gold-standard” methodology would require a multi-decade prospective
study.275
This is an important paper on the relationship between cerebral concussion and
subsequent cognitive impairment in retired professional football players. Its
major flaw, as the authors acknowledge, is that the history of previous
concussion was based on the players’ “retrospective recall of injury events.”
Nonetheless, their data strongly suggests there is a cumulative deleterious effect
of repeated concussion on later cognitive function.276
The present study does not dispel uncertainties regarding the relationship
between repeated concussions and subsequent onset of brain disorders, most
importantly Alzheimer’s disease.... Society must provide the author with the
necessary funds and incentive to do the study correctly based on professionally
obtained prospective data.277
A second article by Guskiewicz, et al., examined another possible long-term
consequence of concussions, specifically a possible connection between MTBIs and
depression in former NFL players. The authors wrote,
272 Ibid., see comments by Donald Marion, p. 725.
273 Ibid., see comments by M.R. Ross Bullock, p. 725.
274 Ibid., see comments by Arthur L. Day, p. 726.
275 Ibid., see comments by Joseph Bleiberg.
276 Ibid., see comments by Daniel F. Kelly, p. 726.
277 Ibid., see comments by Charles H. Tator, p. 726.

CRS-96
The findings from our study of retired professional football players support the
notion that lifetime prevalence of depression and feelings commonly associated
with a depressed state increases as a function of previous head injury exposure....
Our observed threefold prevalence ratio for retired players with three or more
concussions is daunting, given that depression is typically characterized by
sadness, loss of interest in activities, decreased energy, and loss of confidence
and self-esteem. These findings call into question how effectively retired
professional football players with a history of three or more concussions are able
to meet the mental and physical demands of life after playing professional
football. Furthermore, our findings suggest that a single concussion does not
provide the risk for subsequent depression, and they provide an extension to the
findings on the cumulative risk of repeat concussion demonstrated in collegiate
football players. In combination, these suggest that football players with three
or more concussions are at a threefold risk for sustaining future concussions,
with a subsequent threefold risk of being diagnosed with clinical depression
compared with those with limited or no prior history.278
Guskiewicz, et al., then explain the impact that depression may have on an
individual, noting that “[d]epression can affect one’s ability to function in multiple
realms, including interpersonal relationships, productivity at work, and self-care. In
older adults, depression is associated with significantly higher health care costs and
significant risk of functional decline. 279
Additional findings reported by Guskiewicz, et al., in this article suggest that
certain players, because of a combination of injuries and circumstances, may
experience a range of problems during retirement. The following excerpt describes
these circumstances and problems:
Our findings also suggest that, in general, retired professional football players
who have a history of concussion and depressive episodes report greater physical
limitations that interfere with their ability to perform daily physical activities
compared with those without depression. The SF-36 [Short Form 36] results for
mental and physical functioning reveal that those with a history of depression are
more likely to be restricted by muscle and joint pain, feel helpless, have
difficulty sleeping, and, in general feel as though their health is declining.280
Individuals with a history of depression also reported more alcohol-related
problems and were more likely to be separated or divorced.”281
The journal in which this article appeared did not publish any peer review comments
on this article.
278 Kevin M. Guskiewicz, et al., “Recurrent Concussion and Risk of Depression in Retired
Professional Football Players,” Medicine and Science in Sports and Exercise, June 2007,
p. 906.
279 Ibid., pp. 907-908.
280 The title of the SF-36 is “Short Form 36 Measurement Model for Functional Assessment
of Health and Well-Being,” and it “assesses health status and estimates how well a retired
athlete functions with activities of daily living.” (Kevin M. Guskiewicz, et al., “Recurrent
Concussion and Risk of Depression in Retired Professional Football Players,” p. 904.)
281 Ibid., p. 906.

CRS-97
Susceptibility to an Additional MTBI. A study of 2,905 football players,
which was also led by Kevin Guskiewicz, explored the possibility that a player who
has suffered one or more concussions is more likely to sustain an additional
concussion than an individual who has not had any concussions. In a published
article, Guskiewicz, et al., reported that a player who has sustained a concussion, and,
in particular, a player who has sustained three or more concussions, has a greater
probability of having another concussion than a player who has not had three
concussions. The authors wrote,
Players reporting a history of 3 or more previous concussions were 3.0 ... times
more likely to have an incident concussion than players with no concussion
history.... Our study suggests that players with a history of previous concussions
are more likely to have future concussive injuries than those with no history; 1
in 15 players with a concussion may have additional concussions in the same
playing season; and previous concussions may be associated with slower
recovery of neurological function.... These results illustrate that a history of
previous concussions may be associated with an increased risk of future
concussive injuries and that these previous concussion may be associated with
slower recovery of neurological function following subsequent concussions.
Within a given season, there may be a 7- to 10-day window of increased
susceptibility for recurrent concussive injury, but this finding should be further
studied in a larger sample of athletes with recurrent in-season concussions.282
This article was not published in Neurosurgery; hence, there are no comments by
peer reviewers.
In an article on return-to-play considerations, which are used to determine when
it is acceptable, from a medical perspective, for a player who has sustained a
concussion to return to practice or to a game, Pellman, et al., suggest that a player
who has sustained an MTBI does not have a greater risk of sustaining another
concussion than a player who has no history of concussions.
Players who are concussed and return to the same game have fewer initial signs
and symptoms than those removed from play. Return to play does not involve
a significant risk of a second injury either in the same game or during the season.
The current decision-making of NFL team physicians seems appropriate for
return to the game after a concussion, when the player has become asymptomatic
and does not have memory or cognitive problems.283
The NFL experience thus suggests that players who become asymptomatic with
normal examinations at any time after injury, while the game is still in progress,
have been and can continue to be safely returned to play on that day. This
indicates that the ‘15-minutes rule’ in the current guidelines may be too
conservative for the NFL. Many of the currently accepted guidelines also
indicate that any player who experiences loss of consciousness with MTBI
282 Kevin M. Guskiewicz, et al., “Cumulative Effects Associated with Recurrent Concussion
in Collegiate Football Players,” Journal of the American Medical Association, vol. 290, no.
19, Nov. 19, 2003, pp. 2549 and 2554.
283 Elliot J. Pellman, et al., “Concussion in Professional Football: Players Returning to the
Same Game — Part 7,” Neurosurgery, vol. 56, no. 1, Jan. 2005, p. 79.

CRS-98
should not be allowed to return to play that day.... Although the numbers were
small, there were a few players in this study who had recorded loss of
consciousness as a result of MTBI and later returned to play in the same game.
There was no evidence of any adverse effect of this action. These data suggest
that these players were at no increased risk of repeat MTBI or prolonged
postconcussion syndrome compared with other players.284
The peer reviewers’ comments on Pellman, et al., are as follows:
A study of this magnitude has some inherent limitations, as the authors
acknowledge. However, this is an interesting analysis that demonstrates that, at
least in the acute phase and during their active playing years, these athletes seem
to perform well with a risk for intracranial hemorrhage or a later high incidence
of recurrent concussion or postconcussion symptoms.285
The conclusions cited in this article are supported by the data presented....
Multiple studies in the past several years have indicated that the incidence of
concussion cited by the athlete questioned after the season is over is many times
higher, four to seven times, than that currently reported by the team medical
personnel. That most athletes do play through most minor concussions is
supported by these studies.286
The present study evaluated the safety of returning concussed professional
football players to the same game immediately or after a period of rest.... As
would be predicted, players who returned to the same game have significantly
lower incidences of cognitive and memory problems than players removed from
play or hospitalized .... This article essentially confirms that the practice by team
physicians and trainers in the NFL of not allowing symptomatic or neurologically
abnormal athletes to return to play in the same game is a safe practice.287
Return-to-play decisions regarding athletes who sustain concussion can be
difficult for the sports medicine team. Pellman et al., in Part 7, describe signs,
symptoms, and management of NFL players who sustained concussions and
returned to the same game during the 6-year period. The authors of this study
conclude that the results of this NFL study differ from previous articles and did
not reveal the same return-to-play concerns.288
Chronic Traumatic Encephalopathy (CTE). Chronic traumatic
encephalopathy which is also known as dementia pugilistica and is a long-term
problem associated with traumatic brain injury, “primarily affects career boxers. The
most common symptoms of the condition are dementia and parksonism [apparently,
a reference to Parkinson’s Disease] caused by repetitive blows to the head over a long
284 Ibid., p. 88.
285 Ibid., see comments by Julian E. Bailes, p. 90.
286 Ibid., see comments by Robert C. Cantu, p. 91.
287 Ibid., see comments by Joseph C. Maroon, p. 91.
288 Ibid., see comments by Russ Romano, p. 91.

CRS-99
period of time. Symptoms begin anywhere between 6 and 40 years after the start of
a boxing career, with an average onset of about 16 years.”289
In 2002, Dr. Bennet I. Omalu, a neuropathologist and a forensic pathologist with
the Office of the Medical Examiner, Allegheny County, PA, performed the autopsy
of Mike Webster, a former player for the Pittsburgh Steelers, and found signs of CTE
in Webster’s brain.290 Writing in an article that was published in Neurosurgery in
July 2005, Omalu, et al. described what was found during the autopsy and suggested
that additional research was warranted:
... the results of the autopsy of a retired professional football player ... revealed
neuropathological changes consistent with long-term repetitive concussive brain
injury.291 This case draws attention to the need for further studies in the cohort
of retired National Football League players to elucidate the neuropathological
sequelae of repeated mild traumatic brain injury in professional football....
Autopsy confirmed the presence of coronary atherosclerotic disease with dilated
cardiomyopathy.... Chronic traumatic encephalopathy was evident.... This case
highlights potential long-term neurodegenerative outcomes in retired professional
289 National Institutes of Health, National Institute of Neurological Disorders and Stroke,
“Traumatic Brain Injury: Hope Through Research,” available at [http://www.ninds.nih.gov/
disorders/tbi/detail_tbi.htm].
290 Dr. Omalu studied the brains of four former NFL players after they died : Terry Long,
Justin Strzelczyk, Andre Waters, and Mike Webster. Dr. Omalu “found [the brains of the
four players] to have had a condition similar to that generally found only in boxers with
dementia or people in their 80s.... a condition evidenced by neurofibrillary tangles in the
brain’s cortex, which can cause memory loss, depression and eventually Alzheimer’s
disease-like dementia.” (Alan Schwarz, “Lineman, Dead at 36, Shed Light on Brain
Injuries,” New York Times, Jun 15, 2007, p. C14.) Terry Long, a former lineman for the
Pittsburgh Steelers, committed suicide, in Jan. 2006, at age 45 (“Ex-Steeler Long Drank
Antifreeze to Commit Suicide,” Espn.com, Jan. 26, 2006, available at
[http://sports.espn.go.com/espn/print?id=2307003&type=story].) Justin Strzelczyk, who
also had played for the Steelers, as an offensive lineman, was killed, at age 36, in a car
crash. (Schwarz, “Lineman, Dead at 36, Shed Light on Brain Injuries,” p. C18.) Following
his retirement from the NFL, Strzelczyk “spiraled downward ... enduring a divorce and
dabbling with steroid-like substance, and soon before his death complained of depression
and hearing voices from what he called ‘the evil ones.’ He was experiencing an apparent
breakdown the morning of Sept. 30, 2004, when, during a 40-mile high-speed police chase
in central New York, his pickup truck collided with a tractor-trailer and exploded, killing
him instantly.” (Ibid.) Andre Waters, a former defensive back for the Philadelphia Eagles,
committed suicide at age 44 in Nov. 2006. (Ibid.) Mike Webster died at age 50, in Sept.
2002, of heart failure. (Greg Garber, “A Tormented Soul,” Espn.com, Jan. 24, 2005,
available at [http://sports.espn.go.com/nfl/news/story?id=1972285].)
291 Although a diagnosis of CTE is complicated, the following rudimentary description of
the process and effect may be useful: “When slides were made of the [brain] matter [from
Mike Webster], then magnified 200 times, the telltale red flecks of abnormal protein
appeared. The proteins appear when the brain is hit, [Dr. Bennet] Omalu said, but disappear
as the healthy brain cells devour them, leading to recovery. Yet when the brain suffers too
many blows, the brain cells can’t keep up with the protein and eventually give up and die,
leaving just the red flecks.” (Les Carpenter, “‘Brain Chaser’ Tackles Effects of NFL Hits,”
Washington Post, Apr. 25, 2007, p. E4.)

CRS-100
National Football League players subjected to repeated mild traumatic brain
injury. The prevalence and pathoetiological mechanisms of these possible
adverse long-term outcomes and their relation to duration of years of playing
football have not been sufficiently studied. We recommend comprehensive
clinical and forensic approaches to understand and further elucidate this
emergent professional sports hazard.292
Although Omalu, et al., indicate that CTE was evident in Webster’s brain, they also
note that further studies are needed. It appears that this was the first article to
examine the possibility that professional football players could sustain damage
sufficient to cause CTE.
In response to this article, several members of the MTBI Committee submitted
a letter in May 2006 to Neurosurgery critiquing Omalu, et al., and suggesting that
their article should be retracted or revised. An excerpt from Casson, et al., follows:
[We] disagree with the assertion that Omalu et al.’s ... recent article actually
reports a case of ‘chronic traumatic encephalopathy in a National Football
League (NFL) player.’ We base our opinion on two serious flaws in Omalu et
al.’s article, namely a serious misinterpretation of their neuropathological
findings in relation to the tetrad characteristics of chronic traumatic
encephalopathy and a failure to provide an adequate clinical history.... We have
demonstrated that Omalu et al.’s ... case does not meet the clinical or
neuropathological criteria of chronic traumatic encephalopathy. We, therefore,
urge the authors to retract their paper or sufficiently revise it and its title after
more detailed investigation of this case.293
Omalu, et al., replied to the Casson, et al., letter and others in the field of
neurology also commented on the article and the Casson et al. letter. In their reply,
Omalu, et al., explained why they would not withdraw their article and concluded by
encouraging the NFL to study the long-term consequences of MTBI. In concluding
their letter, Omalu, et al., wrote,
In fact, our case is important primarily because it indicates that there may be
brain damage in NFL players that is currently under-reported, because of a lack
of long-term clinical follow-up focused on evaluating such a condition. We
suggest that the NFL begin examining the long-term effects of brain injury in its
former players. We would be happy to collaborate with the Mild Traumatic
Brain Injury Committee and the NFL in developing and implementing an optimal
research program that will address these newly emerging issues.294
292 Bennet I. Omalu, et al., “Chronic Traumatic Encephalopathy in a National Football
League Player,” Neurosurgery, vol. 57, no. 1, July 2005, p. 128.
293 Ira R. Casson, Elliot J. Pellman, and David C. Viano, “Chronic Traumatic
Encephalopathy in a National Football League Player,” correspondence, Neurosurgery, vol.
58, no. 5, May 2006, p. E1003.
294 Bennet I. Omalu, et al., “Chronic Traumatic Encephalopathy in a National Football
League Player,” correspondence, Neurosurgery, vol. 58, no. 5, May 2006, p. E1003.

CRS-101
The following excerpts from others’ letters are provided to show the range of
comments offered by others who addressed Omalu, et al.’s, July 2005 article and
Casson, et al.’s, May 2006 correspondence. Although one correspondent supported
retraction of the Omalu, et al., article; others note the article’s limitations but suggest
that it has value.
... I agree that retraction or a major revision by the authors is warranted.295
They [Casson, et al.] do not dispute his [Omalu, et al.] findings, they simply
dispute the name Omalu et al. have given to those findings.... In summary, I see
the Casson et al. letter as raising several valid points regarding the intrinsic
limitations of the case material used in Omalu et al.’s study. However, because
these limitations were noted by Omalu et al. in the published version, I do not see
the point of publishing a letter reiterating them.296
[Casson, et al.,] should be thanked for compiling this detailed historical review
of our understanding of the neuropathology of chronic brain injury.... Omalu et
al.’s report may serve to stimulate interest in the area of neurodegenerative
histological findings in athletes. However, the bar has clearly been raised.
Future studies will need to use standardized or widely accepted histological
criteria in addition to firm and accurate medical histories.297
Casson et al., conveniently omitted the obvious contribution of this [Omalu, et
al.] study. Namely, this is a seminal study in the field.... Casson et al.’s letter
seems to have exceeded protocol for scientifically providing an additional
opinion for a published story. Specifically, they took an extreme stand in
actually urging the authors to retract the article.... Articles should be considered
for retraction if they contain fabricated data, contamination of data, or allegation
of misconduct. It is my opinion that there is no justification for retracting this
article.298
As members of the Mild Traumatic Brain Injury Committee of the NFL, and
clinician-scientists that are clearly devoted to the investigation of sports-related
concussion, Drs. Casson, Pellman, and Viano should welcome the contribution
from Omalu et al. and consider the findings of that report highly relevant to their
own research, rather than recommending retraction of the article. The need to
obtain more details regarding premorbid neuropsychological deficits and specific
episodes of concussion is clearly recognized and stated by Omalu et al. ... in their
295 Daniel F. Kelly, “Chronic Traumatic Encephalopathy in a National Football League
Player,” correspondence, Neurosurgery, vol. 58, no. 5, May 2006, p. E1003.
296 Joseph Bleiberg, “Chronic Traumatic Encephalopathy in a National Football League
Player,” correspondence, Neurosurgery, vol. 58, no. 5, May 2006, p. E1003.
297 Alex B. Valadka, “Chronic Traumatic Encephalopathy in a National Football League
Player,” correspondence, Neurosurgery, vol. 58, no. 5, May 2006, p. E1003.
298 Kenneth C. Kutner, “Chronic Traumatic Encephalopathy in a National Football League
Player,” correspondence, Neurosurgery, vol. 58, no. 5, May 2006, p. E1003.

CRS-102
paper, but the histopathological findings are clearly described and consistent with
a previous history of brain injury.299
In November 2006, Omalu, et al., presented the results of an examination of the
brain of another retired NFL player. The autopsy confirmed that this individual had
CTE, but it also discovered “neuropathological features that differ from those of the
first reported case.”300 The reasons for the differences were not clear, and, again,
Omalu called for further studies “to identify and define the neuropathological
cascades of chronic traumatic encephalopathy in football players, which may form
the basis for prophylaxis and therapeutics.”301 Excerpts from peer reviewers’
comments are as follow:
This is an interesting study linking the chronic head trauma in professional
football players with chronic traumatic encephalopathy. There is a temporal
association of the symptoms with the patient’s football career. Also, it does not
prove that head injury from playing football was the sole cause of this patient’s
disease; the association is intriguing and is important to report.302
With such multifactorial and incomplete history, I think it is extremely
speculative to suggest that his [former player] psychosocial behavior and
neuropathological findings are attributable to football-induced traumatic
encephalopathy, especially because he demonstrated no residual evidence of a
post concussion syndrome after his one documented cerebral concussion, after
which he returned to full football participation for several years. Nevertheless,
although more than daunting, to perform postmortem neuropathological
examinations on all NFL Hall of Fame inductees would be of interest.303
Following on their initial case report, this autopsy study is of interest and further
raises the question of the possibility of chronic or cumulative effects of multiple,
subclinical concussions resulting in neurodegenerative changes....
Notwithstanding the absence of documentation of multiple clinical concussive
episodes, this case nonetheless stimulates the discussion of whether or not, in a
small number of players, such football exposure can cause a widespread
neurodegenerative process with ultimate clinical manifestations.304
This article adds to the increasing literature regarding cognitive deficits
associated with low-grade repetitive head injury. Although, as a case report, no
299 Donald W. Marion, “Chronic Traumatic Encephalopathy in a National Football League
Player,” correspondence, Neurosurgery, vol. 58, no. 5, May 2006, p. E1003.
300 Bennet I. Omalu, et al., “Chronic Traumatic Encephalopathy in a National Football
League Player: Part II,” Neurosurgery, vol. 59, no. 5, Nov. 2006, p. 1086.
301 Ibid.
302 Ibid., see comments by Kenneth Aldape, p. 1092.
303 Ibid., see comments by Joseph C. Maroon, p. 1092.
304 Ibid., see comments by Julian E. Bailes, p. 1093.

CRS-103
definitive statements can be made, it is important to have such cases presented
and discussed.305
The authors compare and contrast this case with a previous case report. The
relationship of the onset of his depressive disorder after his history of
participation in football is purely temporal. This is a difficult relationship, given
a potential history of antisocial behavior before his retirement. It becomes
additionally more complex given a history of steroid use.306
In the August 2007 issue of Neurosurgery, Robert C. Cantu offered his
comments on the CTE issue.307 Excerpts from his comments follow:
The NFL’s own publications in this journal [Neurosurgery] on concussions state
that they had seen no cases of CTE in the NFL.... That finding is not a surprise
as the NFL study included only active players in their 20s and 30s during a short
6-year window from 1996 to 2001.
It was Corsellis who also reported CTE not only in boxers but other sports with
a high risk of head injury, including those in which head injury occurred in
declining frequency; among these were jockeys (especially steeplechasers),
professional wrestlers, parachutists, and even a case of battered wife syndrome.
With this history, it is no surprise to have cases from NFL football.308
305 Ibid., see comments by Colin Smith, p. 1093.
306 Ibid., see comments by Min Park, Andy Nguyen, and Michael L. Levy, p. 1093.
307 A critique by Cantu of the NFL’s research on MTBI might provide some insight into
why other, though not all, professionals in the field of neurology raise questions about the
articles published by the MTBI Committee. Cantu wrote: “Other significant limitations of
the NFL studies include the following: 1) History of concussion: previous concussions either
in the NFL in the years before the study began or during their playing careers in high school,
college, or other levels of football were not included. 2) The population of NFL players
changes from year to year: new players enter the league, older players leave the league, and
we do not know the number of players who constituted the 1996 population who are still in
the league in subsequent years. 3) There was difficulty collecting data on loss of
consciousness; the initial data collection sheet did not ask for data regarding loss of
consciousness. 4) This was a multisite study with numerous different examiners; there was
no uniform method of evaluation of concussion in this study. 5) Return to play data were
collected on players with initial and repeat concussions: there are many other factors that
go into the decision of whether or not the player should return to play, including the
importance of the player to the team; the importance of the upcoming game to the team; and
pressure from owners, players, and their families, coaches, agents, and media may certainly
influence the final decision on when the player returns to play. 6) The results apply to
mainly NFL-level players: extrapolation to younger players has not been demonstrated.”
(Robert C. Cantu, “Chronic Traumatic Encephalopathy in the National Football League,”
Neurosurgery, vol. 61, no. 2, Aug. 2007, pp. 223-224.) Also see text at footnote 329.
308 Ibid., p. 224. “Corsellis” in this quotation refers to one or both of these articles: J.A.
Corsellis, C.J. Bruton CJ, and D. Freeman-Browne, “The Aftermath of Boxing,”
Psychological Medicine, vol 3, 1973, pp. 270-303; and J.A. Corsellis, “Brain Damage in
Sport,” Lancet, 1, 1976, pp. 401-402.

CRS-104
... I have personally examined and spoken with a number of retired NFL players
with postconcussion/CTE symptoms. Only an immediate prospective study will
determine the true incidence of this problem. Although this study could be
funded by the NFL charities, the NFL should refrain from introducing potential
bias with regard to the team of neurosurgeons, neurologists, neuropsychiatrists,
and neuropathologists with athletic head injury expertise chosen to carry out the
study.309
Finally, it is clear that not all players with long concussion histories have met
premature and horrific ends to their lives. However, as the list of NFL players
retired as a result of post-concussion symptoms (e.g., Harry Carson, Al Toon,
Merril Hoge, Troy Aikman, Steve Young, Ted Johnson, Wayne Chrebet) grows
and as the number of documented CTE cases increases, I believe the time for
independent study of the problem as well as NFL recognition that there is a
problem is now.310
NFL’s Approach to MTBI. It is unclear whether the NFL has, or has had, a
league-wide policy on MTBI that teams — including medical staff, coaches, and
players — are required to follow. A news article from fall 2006 stated: “The NFL
allows each team to manage concussions as it sees fit. When a player is injured, the
team doctor, sometimes with input from trainers and specialists, decides when he can
return to the field.”311 In 2007, following league meetings in March and May, the
NFL undertook several initiatives involving the management of MTBI, which are as
follow:312
! Held a medical and scientific conference (known popularly as the
“concussion summit”) on concussions in June. Physicians and head
trainers from every team, and active players and NFLPA medical
representatives attended. Doctors and scientists from the NFL and
from outside the league gave presentations.
! Prepared a pamphlet for players and their families that, among other
things, describes the symptoms of a concussion.
! Established a hotline to be used for reporting confidentially when a
player is being forced to practice or play despite medical advice that
says he should not play.
! Worked with the NFLPA’s medical advisors, prepared a summary
of key factors to be used by team doctors and athletic trainers in
309 Ibid.
310 Ibid.
311 Keating, “Doctor Yes.”
312 “Goodell Orders Teams to Concussion Meeting,” NFL News, May 2, 2007, available at
[http://www.nfl.com/news/story/10162742]; Letter from Roger Goodell, Commissioner,
National Football League, to Chief Executives, Club Presidents, General Managers, Head
Coaches, Team Physicians, and Head Athletic Trainers, “Materials re Management of
Concussions,” memorandum, Aug. 10, 2007, p. 1.

CRS-105
determining when it is safe for a player to practice, or to return to the
same game in which the concussion occurred.
! Expanded the use of neuropsychological testing so that, before the
beginning of the 2007 season, all NFL players underwent testing.
! Directed that players removed from a game due to a concussion be
re-tested.
! Continued to enforce safety rules involving the use and proper
wearing of helmets. And,

! Continued to research concussions with “a particular focus on long-
term effects” and expanded the membership of its MTBI
Committee.313
The concussion summit included presentations by members of the MTBI
Committee and presentations by at least two neurologists who either have written
articles that conflict with articles published by MTBI Committee members or have
critiqued the committee’s research.
The establishment of a hotline has the potential to aid a player who is pressured
to play after sustaining a concussion or who observes that a teammate is being
pressured to play. It is appropriate to expect a player to take responsibility for his
health, and team personnel may use the hotline, too. However, considering the
financial incentives (as discussed above) that might convince someone to play with
a concussion, some may inquire why owners, coaches, medical staff, and other team
personnel are not prohibited from implicitly or explicitly pressuring a player to
practice, or to play in a game, when it is not medically advisable to do so. As quoted
in a news article, a former tight end for the New Orleans Saints, Ernie Conwell,
addresses this problem and offers a cautionary note that “stiffer guidelines” might
have an unintended effect:
There’s already kind of a counterculture in the N.F.L. of self-treating, of not
letting trainers and doctors know when something’s wrong with you .... My
biggest concern [about stiffer guidelines on how to deal with players who may
have suffered concussions] is that we’ll push players away .... Guys will say
‘Hey man, be careful, you don’t want to say anything about getting dinged
because they might rip you out of the game, or you might be labeled as a guy
with a soft head.314
313 Letter from Roger Goodell, Commissioner, National Football League, and Eugene
Upshaw, Executive Director, NFL Players Association, to NFL players, Aug. 2007, pp. 1-2;
National Football League, “NFL Outlines for Players Steps Taken to Address Concussions,”
news release, Aug. 14, 2007, pp. 1-2.
314 Alan Schwarz, “Player Silence on Concussions May Block N.F.L. Guidelines,” New York
Times, June 20, 2007, available at [http://www.nytimes.com/2007/06/20/sports/
football/20concussions.html].

CRS-106
The case of former New York Jets wide receiver Wayne Chrebet, as reported by
the New York Times, shows how he viewed the decision to play, after having had six
concussions diagnosed during his 11-year NFL career.
“If they took it [the decision to play] out of my hands, there was nothing I could
do about it,” Chrebet said. “I’d have to do what they said.” On the other hand,
if he were not permitted to come back, there might not have been a Wayne
Chrebet with the Jets. He was an undersized receiver from Hofstra, an obscure
college by N.F.L. standards, who felt he did not have the luxury to miss a game.
“Especially players who were in my situation, you can’t afford to take a play
off,” he said. Chrebet cited the story of Wally Pipp, who was replaced in the
Yankees’ starting lineup by Lou Gehrig and never regained his spot. In the
N.F.L., nonguaranteed contracts add to the normal competitiveness and
insecurity. “You take one play off, and somebody takes your spot,” Chrebet said.
“They make a play, [and] it [your career] could be over.315
The last item in the list of NFL initiatives above mentions additional MTBI
research that is planned or ongoing; a list of these studies is in Appendix B.
Additionally, NFL Charities has awarded, during 2003-2007, grants for research
involving, among other things, concussions, MTBI, and related topics. Table 17
includes a list of these grants.
Table 17. Recipients of NFL Charities Grants for MTBI and
Related Research, 2003-2007
Amounts and
Description of Research or Title of
Institution
Years of Grantsb
Study
Biokinetics and
— $189,914
— “MTBI Advanced Concussion
Associates, Ltd.a
2005
Research Study”
— $175,900
— “Concussion studies”
2006
— $105,000
— “MTBI Advanced Concussion
2006
Research Study”
— $111,413
— “MTBI Advanced Concussion
2007
Research Study”
Institute for Injury
— $155,000
— “Concussion-Comparing Injuries in
Researchc
2005
the NFL Animal Model with those from
an Established Head Injury Model by
Marmarou.”
— $75,000
— “Concussions-Studying Protein
2007
Deposits in the Brain After Concussions”
Mark R. Lovell
— $7,500
“NFL Pilot Study Neuropsychological
2007
Testing”
315 Rhoden, “A Jet Who Led With His Head, and His Heart.”

CRS-107
Amounts and
Description of Research or Title of
Institution
Years of Grantsb
Study
University of
— $59,000
“Assessment of brain blood flow
Maryland-
2003
following concussion.”
Baltimore
Wayne State
— $200,000
— “Concussion studies”
University Sports
2003
Labd
— $180,000
— “Concussion studies”
2004
— $45,000
— “Mouth guards-Development of a
2005
Mandible and Teeth for the Hybrid III
Dummy Head to Test the Influence of
Mouth guards on Risk of Concussions”
— $170,000
— “Helmet and Mouth Guard-
2006
Concussion Studies”
— $25,000
— “Mouth guard and Helmet Testing”
2007
— $352,887
— “Helmet Impact Study”
2007
Source: Letter from Roger Goodell, Commissioner, National Football League, to Reps. John Conyers,
Jr., and Lamar S. Smith, Nov. 2, 2007, attachment 8.
a. Biokinetics and Associates, Ltd., is a Canadian firm that, according to its mission statement,
“provides engineered solutions to human impact protection for sports, transportation and
defence/law enforcement applications.” (Biokinetics, “Mission,” available at
[http://www.biokinetics. com/profile_index.html].)
b. Amounts have been rounded to the nearest dollar.
c. David Viano, who is co-chair of the MTBI Committee, is the president of the Institute for Injury
Prevention. (David C. Viano, “Résumé,” provided by the House Committee on the Judiciary to
the author on Nov. 6, 2007, p. 5.)
d. Apparently, the full name of this organization is Sports Injury Biomechanics Lab. David Viano,
who is co-chair of the MTBI Committee, is the director of the Sports Injury Biomechanics Lab.
(Wayne State University, “Sports Injury Biomechanics Lab,” available at
[http://ttb.eng.wayne.edu/]; Viano, “Résumé,” p. 1.)
As reported by ESPN.com, the NFL has taken, or plans to take, some additional
steps regarding its MTBI Committee. Reportedly, the commissioner has told the
MTBI Committee “to involve new researchers in its work,” and a member of the
committee said: “We’re going to reach out to other people, to all the experts in
MTBI, and try to have an open, meaningful scientific dialogue.”316 Thom Mayer, the
NFLPA’s medical advisor, reportedly said: “We [apparently, this is a reference to
the NFLPA] expect to have a seat at the table for virtually anything that occurs from
316 Peter Keating, “NFL Retools Approach to Concussion Research,” ESPN.com, Apr. 20,
2007, available at [http://sports.espn.go.com/nfl/news/story?id=2844041].

CRS-108
this point forward.”317 Additionally, the MTBI committee reportedly has subjected
its research findings “to a new round of statistical analysis....” and has asked team
doctors and consultants to provide “hundreds of neuropsychological tests conducted
on NFL players” that apparently had not been included in studies on the effects of
concussions.318
The “NFL Player Concussion Pamphlet” identifies and describes the most
common symptoms of concussions and also addresses, in question and answer
format, a number of concussion-related subjects. Two of these questions and the
NFL’s responses are as follow:
Am I at risk for further injury if I have had a concussion? Current research with
professional athletes has shown that you should not be at greater risk of further
injury once you receive proper medical care for a concussion and are free of
symptoms.
If I have had more than one concussion, am I at increased risk for another injury?
Current research with profession athletes has not shown that having more than
one or two concussions leads to permanent problems if each injury is managed
properly. It is important to understand that there is no magic number for how
many concussions is too many. Research is currently underway to determine if
there are any long-term effects of concussion in NFL athletes.319
These responses apparently rely exclusively on the MTBI Committee’s studies, for
no mention is made of other research that addresses the possible long-term
consequences of sustaining one or more concussions (this research is presented
above). The following comments by researcher Kevin Guskiewicz and Greg Aiello,
senior vice president of media relations for the NFL, as reported in the New York
Times, capture the different perspectives:
[Kevin Guskiewicz] noted that “The first half of their statement is false.... And
the second part, if they’re managed properly? What does that mean? They’re
just trying to raise ambiguity when the science is becoming more and more
clear.” Greg Aiello, NFL spokesman, responded in a statement: “We certainly
respect the work that Dr. Guskiewicz and others have done on this subject and
look forward to continuing to work with him. Our medical advisers, including
neurosurgeons and neurologists, do not fully share his view of the science. We
are conducting research on long-term effects of concussions that we hope will
clarify this important issue.”320
317 Ibid.
318 Ibid.
319 National Football League, “NFL Player Concussion Pamphlet,” n.d. (Considering the
context in which a reproduction of pamphlet material was received, the pamphlet most likely
was produced in 2007.)
320 Schwarz, “For Jets, Silence on Concussions Signals Unease,” p. A20.

CRS-109
Another development in 2007 was that the MTBI Committee reaffirmed the
following summary of return-to-play considerations for players who sustain
concussions:
Team physicians and athletic trainers should continue to exercise their clinical
judgment and expertise in the treatment of each player who sustains a concussion
and to avail themselves of additional expert consultation when clinically
indicated. We encourage team physicians and athletic trainers to continue to take
a conservative approach to treating concussion.
Team physicians and athletic trainers should continue to take the time to obtain
a thorough history, including inquiring specifically about the common symptoms
of concussion, and to conduct a thorough neurological examination, including
mental status testing at rest and post-exertional testing, before making return to
play decisions in a game or practice.
The essential criteria for consideration of return to play remain unchanged. The
player should be completely asymptomatic and have a normal neurologic
examination, including mental status testing at rest and post-exertional testing,
before being considered for return to play.
Team physicians and athletic trainers should continue to take into account certain
symptoms and signs that have been associated with a delayed recovery when
making return to play decisions. These include confusion, problems with
immediate recall, disorientation to time, place and person, anterograde and
retrograde amnesia, fatigue, blurred vision and presence of three or more signs
and symptoms of concussion.
If the team medical staff determines a player was unconscious, the player should
not be returned to the same game or practice.
Team physicians and athletic trainers should continue to consider the player’s
history of concussion, including number and time between incidents, type and
severity of blow, and time to recover.
Team physicians and athletic trainers should continue to educate players about
concussion and to emphasize the need for players to be forthright about physical
and neurological complaints associated with concussion.321
The third item from the bottom, which advises that a player who was
unconscious should not be returned to the same game or practice, appears to conflict
with an article written by members of the MTBI Committee. The relevant portion
of the 2005 Neurosurgery article is as follows:
Many of the currently accepted guidelines also indicate that any player who
experiences loss of consciousness with MTBI should not be allowed to return to
play that day .... Although the numbers were small, there were a few players in
this study who had recorded loss of consciousness as a result of MTBI and later
returned to play in the same game. There was no evidence of any adverse effect
321 Letter from Roger Goodell, Commissioner, National Football League, and Eugene
Upshaw, Executive Director, NFL Players Association, to NFL players, Aug. 2007, p. 5.

CRS-110
of this action. These data suggest that these players were at no increased risk of
repeat MTBI or prolonged postconcussion syndrome compared with other
players.322

Without additional information, the reason for the discrepancy between the league’s
return-to-play guidelines and the committee’s article is unknown. The league’s
general counsel reportedly stated that the NFL was “‘erring on the side of player
safety ... it may be that a player will be held out of a game when it is not medically
required or indicated by the data. Certainly it’s a less-risky approach in terms of
player safety.... It reflects an effort to avoid this debate going forward.’”323
In the same Neurosurgery article, Pellman, et al., also discuss various factors
that may play a role in deciding when a player may return to the game or practice.
They cite the player’s medical condition as the most important factor, but then appear
to acknowledge that other considerations also may influence the return-to-play
decision. Pellman, et al., wrote:
Although the medical condition of the player certainly is the most important
factor in determining return-to-play decisions by team physicians, there are many
other factors that go into the decision of when the player should return to play.
The importance of the player to the team; the importance of the game to the
team; and pressure from owners, players and their families, coaches, agents, and
media certainly may influence the decision of when the player returns to play.
The authors believe, however, that the medical factors regarding the patient’s
recovery are and should be the overriding factors that guide the team physicians’
decisions-making on return to play.324
Funding for the Retirement Plan
Maintaining full funds for the retirement plan is a priority of the NFL and the
NFLPA, and is made possible by the use of actuarial assumptions (or factors) and
methods, and by ensuring that benefits are awarded only to eligible individuals.
Under the CBA, the amount of money needed to fund certain benefits, including the
retirement plan, is determined using “negotiated actuarial factors.”325 The factors (or
assumptions) are “determined by collective bargaining” and are “acceptable to the
plan’s Enrolled Actuary.”326 At a congressional hearing in 2007, the plan counsel
322 Elliot J. Pellman, et al., “Concussion in Professional Football: Players Returning to the
Same Game — Part 7,” p. 88.
323 Alan Schwarz, “New Advice by N.F.L. in Handling Concussions,” New York Times, Aug.
21, 2007, available at [http://www.nytimes.com/2007/08/21/sports/football/
21concussions.html].
324 Elliot J. Pellman, et al., “Concussion in Professional Football: Players Returning to the
Same Game — Part 7,” p. 89.
325 NFL Players Association, “History of Retirement and T&P Benefits for NFL Players,”
p. 5. In 1993, a single plan counsel, Groom Law Group, and a single plan actuary, Aon
Corporation, were selected for the retirement plan. (Ibid.)
326 NFL Players Association, “History of Retirement and T&P Benefits for NFL Players,”
(continued...)

CRS-111
stated: “Because of the repeated increases in benefits and thus liabilities, the
Retirement Plan is somewhat under funded from an actuarial point of view. Both the
Players Association and the NFL view pension funding as a priority, and full funding
may occur in the next few years, at least until the next negotiated benefit increase.”327
The use of actuarial assumptions and methods is necessary to ensure that a
benefit plan has sufficient funds to meet its obligations — that is, to pay benefits to
eligible individuals. Accordingly, it is necessary “that only those persons who
qualify for the benefits receive them.”328 According to an article that appeared in the
Washington Post Magazine, and which quoted the executive director of the NFLPA,
Gene Upshaw, the players association is committed to ensuring that funds are
available for eligible players. An excerpt from the article follows:
[Gene Upshaw] fears that, if disability payments “go to any borderline cases out
there,” the floodgates will open, and there “might be thousands” of claims from
NFL reitrees who will “say they hurt somewhere on their bodies.... Heck, a lot
of guys have little things.” He says that the league couldn’t endure such a press
of claims. “We couldn’t afford that,” he says. “And the [active] players
wouldn’t go for it.... The players right now give up $82,000 a year [on average]
to fund all the things we’re doing with disability [payments] and pensions.... We
can’t pay for everything for all the [retirees] asking for it. We want to protect
money for the retired players who really need and deserve it.”329
Appendix J of the CBA contains the actuarial assumptions and actuarial cost
method used to determine how much money is needed to fund the benefits provided
by the retirement plan.330 Calculations that use these assumptions and cost method
determine how much money is needed to fund the retirement plan. Some of the
actuarial assumptions in Appendix J are based on established tables, such as the 1980
Railroad Retirement Board rates, which is used for the “Remarriage and mortality
rates for widow’s benefit” factor; and The RP-2000 Table, which is used for
“Mortality rates” and “Disability mortality before age sixty-five.”331 The “Football
326 (...continued)
p. 5; Letter from Goodell to Reps. Conyers and Smith, p. 10.
327 U.S. Congress, House Committee on the Judiciary, Subcommittee on Commercial and
Administrative Law, “The National Football League’s System for Compensating Retired
Players: An Uneven Playing Field?” statement of Douglas W. Ell, Plan Counsel for Bert
Bell/Pete Rozelle NFL Player Retirement Plan, unpublished hearing, 110th Cong., 1st sess.,
June 26, 2007, p. 10.
328 U.S. Congress, House Committee on the Judiciary, Subcommittee on Commercial and
Administrative Law, The National Football League’s System for Compensating Retired
Players: An Uneven Playing Field?” statement of Dennis Curran, Senior Vice President,
National Football League, unpublished hearing, 110th Cong., 1st sess., June 26, 2007, p. 4.
329 Leahy, “The Pain Game,” p. 22.
330 National Football League and NFL Players Association, NFL Collective Bargaining
Agreement, 2006-2012, p. 203.
331 National Football League and NFL Players Association, NFL Collective Bargaining
Agreement, 2006-2012, pp. 282-283. The 1980 Railroad Retirement Board rates are
(continued...)

CRS-112
related disability rates” factor apparently is not based on a table. Instead, the
disability rates are the following: “As of April 1, 2007, the rates are “[.10%] per year
for active players and [.08%] per year for inactive players until age forty-five, after
which it becomes zero. Active players are assumed to become inactive after one year
or age thirty, whichever comes later.”332 The method and information used for
determining these rates is unclear. The NFLPA has noted that “the amount to fund
the Retirement Plan is calculated actuarially, in accordance with federal law.”333 Is
it possible that retired (that is, inactive) players’ needs for medical care exceed the
amount of funds for disability benefits that are calculated using this disability rate?
What Is the Extent of the NFLPA’s Capacity?
The extent of the NFLPA’s authority and capabilities regarding health and safety
issues, and its position on such issues are, at times, unclear. For example, the NFL
has a number of committees that deal with injuries, safety, and health. Apparently,
the NFLPA does not have any similar committees or entities, although, along with
the NFL, it is part of the joint committee on player safety and welfare.334 The
NFLPA has a medical advisor; but, apparently, this is not a full-time position, for the
current advisor is CEO and president of BestPractices and chairman of the
Department of Emergency Medicine, Inova Fairfax Hospital.335 Additionally, it is
unclear what resources, including staff, are available to the medical advisor.
The NFLPA apparently is not included in discussions about proposed rule
changes that may affect the health and safety of players. Furthermore, the description
of the process for addressing rule changes that might adversely affect player safety
shows that, ultimately, neither the joint committee, the players association, nor the
331 (...continued)
available at U.S. Railroad Retirement Board, “Financial, Actuarial and Statistical,”
[http://www.rrb.gov/mep/fin_act_stat.asp]. The other document ,The RP-2000 Mortality
Tables, is available at [http://www.soa.org/files/pdf/rp00_mortalitytables.pdf].
332 National Football League and NFL Players Association, NFL Collective Bargaining
Agreement, 2006-2012, p. 282.
333 Letter from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, p. 29.
334 In the absence of evidence of the committee’s accomplishments, certain features of the
committee suggest that its influence might be limited. The committee holds only two
regular meetings per year, although special meetings may be convened, and the committee
does not have the power “to commit or bind” the NFLPA or the NFL on any issues.
(National Football League and NFL Players Association, NFL Collective Bargaining
Agreement, 2006-2012, Mar. 8, 2006, p. 38.) The names of the NFLPA’s 13 departments
are: Benefits Department, Communications Department, Executive Department, Finance and
Asset Management Department, Financial Programs and Advisor Administration
Department, Information Systems, Legal Department, Membership Services, NFL
PLAYERS Department, NFLPA Retired Players Department, Player Development,
Regional Directors, and Salary Cap and Agent Administration. (NFL Players Association,
“ D e p a r t me n t s , ” n . d . , avai l abl e at [ ht t p : / / w w w . n f l p l a ye r s . c o m/ u s e r /
template.aspx?fmid=181&l mid=238&pid=0&type=l].)
335 Letter from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, p. 11.

CRS-113
arbitrator (if one is involved) has authority to modify or rescind a potentially
problematic proposed rule change. (The issue of rule changes is discussed above.)
The subject of MTBI research and guidelines, in particular, raises several
questions regarding whether the players association has sufficient capacity and
authority to participate effectively in matters involving safety and health issues. For
example, while members of the MTBI Committee have been involved in an ongoing
dialogue with other professionals in the field of neurology (as documented above),
it appears that the NFLPA has not commented publicly on any of the issues, such as
the possible long-term effects of concussions and the possibility that multiple mild
traumatic brain injuries could result in CTE. The NFLPA has “supported and/or
participated in several studies concerning the physical effects of playing professional
football.”336 Those studies include “[s]tudies conducted by the Center for the Study
of Retired Professional Athletes at the University of North Carolina at Chapel Hill,
including the ‘Recurrent Concussion and Risk of Depression in Retired Professional
Football Players’ study done by Dr. Kevin M. Guskiewicz and others in 2006.”337
A joint NFL-NFLPA letter on concussions and concussion management noted
that the NFLPA’s medical advisor had attended the June 2007 “concussion summit”
and that he “will remain closely involved” in ongoing projects involving MTBI
research.338 The extent of the authority of the NFLPA medical advisor regarding the
committee’s decisions, actions, and recommendations is unclear, as are his possible
courses of action, if any, should he disagree with the decisions of the committee.
Additionally, the NFLPA’s involvement in the MTBI’s development of the
concussion management guidelines and, specifically, the return-to-play guidelines is
unclear.
Medical Care for Active Players
Access to Medical Records. Under the CBA, a player may examine his
medical records and athletic trainers’ records only twice per year: “once during the
pre-season and [once] after the regular season.”339 Additionally, he may obtain a
copy of the records during the off-season.340 The rationale for not permitting a player
to see his records during the pre-season and regular season is unclear. While
obtaining records after the season is useful for the player who wants to, among other
336 Ibid., p. 12.
337 Ibid., pp. 12-13.
338 Letter from Goodell and Upshaw to NFL players, pp. 1-2.
339 National Football League and NFL Players Association, NFL Collective Bargaining
Agreement, 2006-2012, p. 199. Having access to one’s medical records, albeit only twice
per year, apparently is an improvement. As quoted in the New York Times in 2002, Gene
Upshaw noted the following changes to players’ medical care: “‘Before 1986-87, guys could
not select the doctor for their surgery, they could not get second opinions and they could not
even see a copy of their medical records.... All of that is in place now.” (Thomas George,
“Care by Team Doctors Raises Conflict Issue.”)
340 National Football League and NFL Players Association, NFL Collective Bargaining
Agreement, 2006-2012, p. 199.

CRS-114
things, maintain his own medical history, timely access to the records might be useful
to a player who has been injured and is receiving, or has received, medical treatment.
Furthermore, a player might be more likely to recognize inaccurate, incomplete, or
erroneous information if he is permitted to examine his records during the season,
rather than having to wait until the conclusion of the season. Team medical staff,
however, may not have time during the season to provide access to, or copies of,
medical records, because they are fulfilling their primary responsibility, which is to
diagnose and treat injured players. The access issue also raises the question of
whether a player is permitted to have corrections added to his health records.
In a reminder to players to review their medical records following the season,
the NFLPA touched on several issues related to the importance of knowing what is
in medical records created and maintained by the team. The NFLPA stated the
following:
With injuries being such a critical factor in determining the quality and longevity
of an NFL player’s career, it is important for players to become knowledgeable
about the injuries they sustain and to learn what their club medical staff thinks
about those injuries....
According to Tim English, NFLPA Staff Counsel who regularly represents
injured NFL players in Injury Grievance arbitrations, “players who review their
club’s medical records for the first time while preparing their arbitrations are
often surprised to read what has been written about their injuries by the club
doctors and trainers. The level of detail in the records far exceeds what is told
to them by the club.” Invariably, those players regret not having taken the time
to review their records previously.
Many times, the additional information contained in the club’s records may assist
a player in planning or altering his off-season treatment and training activity. All
too often during the season a player who sustains an injury is only focused on
getting back out on the field, and not on the extent of his injury and the best
course of action to take for long-term health. The off-season is therefore the time
to re-evaluate those injuries, and a review of the club medical and trainers’
records is the place to start.341
Arrangements for Medical Care and Treatment. Article XLIV of the
CBA governs the players’ right to medical care and treatment. As the employer, a
team provides medical care for its players, which includes team physicians and
athletic trainers. Under the CBA, a team’s medical staff must include a board-
certified orthopedic surgeon; the team is responsible for the cost of medical services
that its physicians provide; and all full-time head trainers and assistant trainers must
be certified by the National Athletic Trainers Association.342
341 NFL Players Association, “News and Events: Off-Season and Medical Records, Off-
Season Is the Time for Players to Review Their Medical Records,” available at
[http://www.nflpa.org/newsandevents/021908.aspx] as of Feb. 21, 2008, on file with the
author.
342 National Football League and NFL Players Association, NFL Collective Bargaining
(continued...)

CRS-115
Article XLIV includes several additional safeguards for players, including the
following:
If a Club physician advises a coach or other Club representative of a player’s
physical condition which adversely affects the player’s performance or health,
the physician will also advise the player. If such condition could be significantly
aggravated by continued performance, the physician will advise the player of
such fact in writing before the player is again allowed to perform on-field
activity.343
While the requirement to provide written notification to a player is an important
safeguard, it is unclear whether this step would be feasible in some situations. For
example, is it possible to provide written notification to players during a game?
A player may seek a second opinion, and he may have his team pay for the costs
associated with doing so as long as he follows this provision in the CBA:
A player will have the opportunity to obtain a second medical opinion. As a
condition of the responsibility of the Club for the costs of medical services
rendered by the physician furnishing the second opinion, the player must (a)
consult with the Club physician in advance concerning the other physician; and
(b) the Club physician must be furnished promptly with a report concerning the
diagnosis, examination and course of treatment recommended by the other
physician.344
At least one former team doctor has suggested, however, that some players may
believe the team prefers that they not seek a second option. As quoted in a news
article, Dr. Robert Huizenga, a team doctor for the Oakland Raiders and past
president of the National Football League Team Physicians Society, “said he always
suspected that the Raiders he treated believed it would be held against them if they
sought a second opinion. ‘Some of them were afraid to even admit to being injured
at all,’ Dr. Huizenga said....”345 Although it is not known whether any team has
discouraged a player from seeking a second opinion, the expense involved and the
possibility that a non-team doctor’s diagnosis and recommendation for treatment
might conflict with, or be more costly than, the team doctor’s diagnosis and
recommendation might have some bearing on a team’s perspective on second
opinions. It is unclear whether the team would be required to pay for any non-
surgical treatment recommended by a non-team physician. Under the CBA, a team
will pay for a player’s surgery regardless of who — team doctor or non-team doctor
— performs the surgery:
342 (...continued)
Agreement, 2006-2012, p. 197.
343 Ibid.
344 Ibid.
345 Bill Pennington, “Sports Medicine; Sports Turnaround: The Team Doctors Now Pay the
Team,” New York Times, May 18, 2004, available at [http://query.nytimes.com/
gst/fullpage.html?sec=health&res=9501E6D8153FF93BA25756C0A9629C8B63].

CRS-116
A player will have the right to choose the surgeon who will perform surgery
provided that: (a) the player will consult unless impossible (e.g., emergency
surgery) with the Club physician as to his recommendation as to the need for, the
timing of and who should perform the surgery; and (b) the player will give due
consideration to the Club physician’s recommendations. Any such surgery will
be at Club expense; provided, however, that the Club, the Club physician,
trainers and any other representative of the Club will not be responsible for or
incur any liability (other than the cost of the surgery) for or relating to the
adequacy or competency of such surgery or other related medical services
rendered in connection with such surgery.346
The condition that requires a player to “give due consideration” to the team
physician’s recommendations might be open to interpretation. Specifically, this
phrase might concern how much discretion a player has, or how much discretion he
thinks he has, to select his own surgeon, which could differ from the team’s view on
how much discretion a player has.
Another issue regarding the medical care provided to players is the potential for
a conflict of interest. Some would argue that a team physician, as an employee of the
team, might find it challenging to balance the interests of his patients — players —
with the interests of the coaches, if not the team owners. The following excerpt from
a news article describes the issue: “There is a complex tapestry occurring in players’
medical treatments. Coaches often want players rushed back onto the field to win
games. Players themselves often push to get back quickly. But when some injured
players balk, coaches and teammates might consider them loafers and pressure them
to return. Coaches pressure doctors for medical releases for players to play. And
trainers are often caught in the middle, receiving pressure from coaches and even
from owners to influence doctors’ decisions.”347 A former assistant team physician
with the Carolina Panthers, Dr. Walter Beaver, indicated, though, that in his
experience, “‘[y]ou had total authority to take care of the players the way you felt
they should be taken care of.... They (team officials) would never question it.’”348
A team physician for the Pittsburgh Steelers, Jim Bradley, also has asserted that his
team’s head coach did not intervene in medical decisions. Reportedly, Bradley said:
“‘If I tell Bill (Cowher, the [former] Steelers coach) a guy can’t go, he never gives
me any problem.... It’s my call.’”349 A related issue is the possibility that the premier
players on a team receive better medical treatment than other players. During a
malpractice suit against a former team doctor, it was “revealed that players believe,
in some cases, that star players are treated differently medically than lesser
players.”350 Reportedly, the executive director of the NFLPA stated: “‘We never
346 Ibid.
347 Thomas George, “Care by Team Doctors Raises Conflict Issue.”
348 Charles Chandler, “Consent at Heart of Lawsuit Facing Panthers, Doctor; Four Ex-
Panthers Say Surgeries Went Further Than They Expected,” Charlotte Observer, p. 1A.
349 Vergano, “NFL Doctors, Players Face Off Over Painful Choices.”
350 Thomas George, “Care by Team Doctors Raises Conflict Issue.” The player, Jeff Novak,
an offensive lineman for the Jacksonville Jaguars, filed a lawsuit against Stephen Lucie,
(continued...)

CRS-117
know if it’s the patient-doctor relationship or the doctor-owner relationship’ that
matters in a team’s medical decisions.’”351 In 2002, it was reported that the NFLPA
and the league were “seeking a uniform standard for the relationships between team
doctors and players and to make them more doctor-patient relationships. The league
wants players treated effectively and fairly but also wants to protect its teams from
expensive liability awards.”352 The status of this effort is unclear.
A related issue is the nature of the business arrangement between a team and its
medical staff. As described in the following excerpt, some doctors (or their medical
practices) pay a team for the privilege of serving as team doctor(s).
In an upside-down scenario spawned by an increasingly competitive health-care
market, hospitals and medical practices — eager for any promotional advantage
— have begun bidding to pay pro teams as much as $1.5 million annually for the
right to treat their high-salaried players. In addition to the revenue, sports
franchises get the services of the provider’s physicians without charge or at
severely discounted rates. In return, the medical groups and the hospitals are
granted the exclusive right to market themselves as the teams’ official hospital,
H.M.O. or orthopedic group.... Despite concerns among many doctors and the
players’ unions over the ethics of putting health care out to bid, about half the
teams in the four major North American professional sports are now tied
contractually to a medical institution.... 353
Criticism is generally not directed at the quality of medical care dispensed,
because it is difficult, if not impossible, to ascertain how these marketing
arrangements directly affect player treatment. Almost everyone agrees that the
pool of sophisticated sports medicine practitioners is so deep that the level of
care is likely to be excellent. But the manner in which the doctors and the
hospitals are selected and the potential for conflicts of interest bother many
people in sports....354
350 (...continued)
who had been a Jacksonville team doctor, and won a $5.35 million malpractice award. A
news article summarized Novak’s story as follows: “[Novak] injured his right knee in
training camp on July 28, 1998. Lucie drained blood and fluid from the knee on Aug. 3 in
a training room at Alltel Stadium. Two days later, Novak returned to practice, but by Sept.
10 had staph and E-coli infections in the knee and had bleeding episodes. Two operations
followed. Novak ... played in only three more games that season, and was not offered a new
contract and retired. Lucie testified that he ‘had a patient who was in a lot of pain who was
having trouble walking around and wanted relief; the best way to provide relief was to
remove this pressure and drain the hematoma.’ Doctors testifying for Novak said that he
should have rested after the surgery, that it was performed in an unsterile environment, that
maybe Novak should not have had the surgery at all but should have allowed the knee to rest
and heal.” (Ibid.)
351 Vergano, “NFL Doctors, Players Face Off Over Painful Choices.”
352 Thomas George, “Care by Team Doctors Raises Conflict Issue.”
353 Pennington, “Sports Medicine; Sports Turnaround: The Team Doctors Now Pay the
Team,” New York Times.
354 Ibid.

CRS-118
Although the medical care provided may not suffer as a result of the business
relationship between a team and its team doctor or doctors, concern persists about the
appearance of a conflict of interest. Reportedly, Dr. Andrew Bishop, the Atlanta
Falcons’ team doctor for 11 years, said: “‘It compromises you as a physician.... The
perception is that if this individual was so eager to do this he’s willing to pay to do
it, then he’s going to do whatever management wants to keep the job he paid for.’”355
Dr. James Bradley, president of the N.F.L. Physicians Society, counters this notion,
reportedly saying: “‘If you are an N.F.L. team doctor and don’t have the best interests
of the players in mind ... you are a fool.’”356 Reportedly, a spokesman for the
NFLPA, Carl Francis, said: “‘We’re always concerned about the relationships
between teams and physicians.... But we’re willing to give the teams the benefit of
the doubt. You would hope that a corporate relationship wouldn’t prevent a team
from doing the proper research before hiring a medical staff.’”357 A final comment
on the topic comes from a player, Troy Vincent, then president of the NFL Players
Association. Vincent was quoted in a news article as saying: “‘Our medical care is
the only part of our game that isn’t regulated.... There are uniform rules on
everything else, including how to wear your uniform socks. Shouldn’t there be some
rules about who gets to treat the players when they’re injured? That’s when we are
most vulnerable, and we should know that the doctor who comes out on that field to
help us is the best around, chosen because he is the best, and not for any other
reason.’”358
Workers’ Compensation
The NFLPA and the NFL have taken steps to ensure that workers’
compensation, which is administered by states, is available to NFL players. The
players association has taken steps to ensure that all players are covered by workers’
compensation, and “has established a panel of qualified lawyers to help players file
and pursue their claims.”359 Similar to other benefits, funding for workers’
compensation comes from the portion of the league’s total revenues that is allocated
to the players. A player may receive both disability benefits and workers’
compensation, and the players association and the league have agreed that the
disability benefits will not be reduced.360 The NFLPA has written that it “strongly
advises each player to preserve his rights under Workers’ Compensation for life-time
medical care for his football injuries.”361
355 Ibid.
356 Ibid.
357 Mike Bianchi, “Doctors, Teams, Players Work in Strange Ways,” Orlando Sentinel, Sept.
17, 2003, p. D1.
358 Pennington, “Sports Medicine; Sports Turnaround: The Team Doctors Now Pay the
Team.”
359 Letter from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, p. 4; NFL Players
Association, “NFLPA White Paper,” p. 21.
360 Ibid.
361 Ibid.

CRS-119
Since workers’ compensation is administered by states, benefits, requirements,
and filing procedures may vary by team location. As the NFLPA has noted, “every
state has a time limit within which to file a claim, which could be as short as one (1)
year from the date of injury.”362 Despite the efforts of the NFLPA to publicize
workers’ compensation benefits, some players might not explore this option until, for
example, they retire or one or more disabilities arise, when it might be too late for
them to apply. A successful application for workers’ compensation benefits might
limit a player’s options for recourse concerning his team (including the team’s
medical staff), which might serve as a deterrent to some players. Generally, an
individual who files for and receives workers’ compensation may not be permitted
to file a lawsuit against his employer.363 Reportedly, the trial of a former team doctor
who was sued by a player “showed that workmen’s compensation laws and the
league’s current collective bargaining agreement protect some doctors and teams
from litigation unless ... they are independent contractors.”364
Possible Courses of Action
The subject of injuries, chronic health problems, disabilities (interpreted
broadly), and benefits for former players is a complex one, and involves a variety
issues, some of which are discussed in this report. Accordingly, developing possible
courses of action is a challenging undertaking, particularly given the
interrelationships among different facets and issues.

The next section examines three proposals offered by the NFLPA, while the
following section explores other possible options.
NFLPA’s Suggestions for Legislative Action
At a hearing in September 2007, the executive director of the players association
proposed three legislative options.365 The NFLPA did not discuss how it developed
these proposals, including whether the suggestions were based on any data or
documentation.
362 NFL Players Association, “CBA: Workers’ Compensation Benefits.”
363 Cornell University Law School, Legal Information Institute, “Workers Compensation,”
n.d., available at [http://www.law.cornell.edu/wex/index.php/Workerscompensation];
Gregory P. Guyton, “A Brief History of Workers’ Compensation,” Iowa Orthopaedic
Journal, 1999, available at [http://www.pubmedcentral.nih.gov/articlerender.fcgi?
artid=1888620], pp. 108-109; California Department of Industrial Relations, “Division of
Workers’ Compensation - Employer Information,” n.d., available at [http://www.dir.ca.gov/
dwc/Employer.htm].
364 Thomas George, “Care by Team Doctors Raises Conflict Issue.”
365 U.S. Congress, Senate Committee on Commerce, Science, and Transportation, “Oversight
of the NFL Retirement System,” statement of Eugene Upshaw, Executive Director, NFL
Players Association, unpublished hearing, 110th Cong., 1st sess., Sept. 18, 2007, p. 3.

CRS-120
Establish Federal Standards for Workers’ Compensation. The
NFLPA suggested that the federal government develop federal standards for workers’
compensation, which currently is administered by states. The players association
argues that the current system “causes the vast majority of hurt workers, not just NFL
players, to settle for a lump sum, and give up their rights to lifetime medical care for
their injuries on the job.”366 Without additional, detailed information about states’
workers’ compensation systems or programs, including data about the disposition of
workers’ compensation applications, the extent of the problem raised by the NFLPA
is unknown. This suggestion might be interpreted as applying to all employers and
employees, and not just the NFL and professional football players, yet it would be
helpful to have an explicit declaration of the scope of the suggestion. In any case,
whether the suggestion is for the NFL only or for all employers, the implications of
such a change could be far-reaching. Another consideration is whether, since states,
historically, have been responsible for administering workers’ compensation, this is
an area in which the federal government would want to intervene. In sum, additional,
detailed information is needed in order to assess this proposal.
Permit Unions to Manage Their Benefit Plans. The NFLPA suggested
that the Taft-Hartley Act (29 U.S.C. §§141-197) should be changed to allow the
players association, if not all unions, to manage their own “plans.” It appears that the
NFLPA is referring to 29 U.S.C. §186(c)(5)(B), which requires that a plan subject to
the act be administered by a board of trustees, and that the union and the employer
be represented equally on the board. As with the first proposal, it is unclear whether
the NFLPA is suggesting this change for only the NFL-NFLPA retirement plan, or
for all negotiated retirement plans. If the NFLPA is proposing that the suggested
change to the Taft-Hartley Act apply to all negotiated plans, it is unclear how other
unions and employers might respond to the NFLPA’s suggestion.
The rationale offered by the NFLPA for amending the Taft-Hartley Act is as
follows: “since the NFLPA has been criticized when applications are denied (even
though a majority vote of the six trustees is necessary for a decision), and since
current players are funding the system, it makes sense for the players to be the ones
making the disability decisions.”367 The players association has also said that
“allow[ing] the trustees appointed by the NFLPA to have the sole responsibility to
decide applications for disability benefits ... [would] avoid deadlocks and expedite
payments.”368
Changing the composition of the Retirement Board might not significantly
affect the application approval rate, which means that criticism of the NFLPA might
not lessen. As the NFLPA executive director noted in his comments regarding this
proposal, “the negotiated contribution by employers is fixed and plan actions cannot
impose extra liability.”369 Thus, the NFLPA does not assert that changing the
366 Ibid., p. 3.
367 Ibid., p. 3.
368 Letter from Upshaw to Reps. Conyers, Smith, Sanchez, and Cannon, p. 14.
369 U.S. Congress, Senate Committee on Commerce, Science, and Transportation,
(continued...)

CRS-121
composition of the board would result in an increase in overall payments.
Furthermore, as mentioned above, the plan counsel testified that the retirement plan
is underfunded actuarially. However, one of the suggestions presented below,
regarding the Sports Broadcasting Act of 1961, includes a mechanism that, if
enacted, might yield additional funds for benefits.
While it might be important symbolically for the board to consist solely of
NFLPA representatives, the substantive significance of the second element of the
NFLPA’s rationale for this proposal — players fund the retirement plan — is not
readily apparent. Furthermore, under the proposed arrangement, the NFLPA alone
most likely would bear the brunt of criticism about the disability application process,
whereas currently both the league and the players association might be viewed as
sharing responsibility for the Retirement Board’s decisions.
In his testimony, the NFLPA’s executive director mentioned “six trustees,”
which suggests that he was referring to the Retirement Board (the DICC has only two
members) when he proposed that the NFLPA choose all of the individuals who make
disability application decisions. Giving the NFLPA sole responsibility for the
decisions of the Retirement Board would, according to the players association, end
deadlocked votes which, in turn, would aid in expediting payments to applicants.
Currently, resolving tie votes involves sending the applicant to a medical advisory
physician or using arbitration (the arbitration is among the board members; the
applicant “is not a party to the arbitration”).370 Thus, if there are no deadlocks, the
application process would end with the board’s decision.
Eliminate the Requirement for the Disability Initial Claims
Committee (DICC). In his 2007 testimony, the NFLPA’s executive director asked
Congress to eliminate the requirement to have “an extra level of decision-making in
disability decisions.” The executive director appeared to be referring to 29 CFR
§2560.503-1(h)(3)(ii) and (4), which require a disability plan to have a mechanism
for an applicant to appeal an adverse benefit determination, and stipulate that neither
the individual who made the adverse determination, nor anyone subordinate to this
individual, can hear the appeal. No rationale accompanied the NFLPA’s suggestion,
although it seems likely that this step would decrease the amount of time needed to
process applications.
On the one hand, eliminating a level of review might reduce the cost and
duration of the application process as a whole. On the other hand, as the plan
counsel, Douglas W. Ell, testified in 2007, “... one man’s ‘red tape’ is another man’s
due process.” 371 The application process, as summarized by Ell, is as follows:
369 (...continued)
“Oversight of the NFL Retirement System,” statement of Eugene Upshaw, p. 3.
370 U.S. Congress, House Committee on the Judiciary, Subcommittee on Commercial and
Administrative Law, The National Football League’s System for Compensating Retired
Players: An Uneven Playing Field? statement of Douglas W. Ell, p. 15.
371 Ibid., p. 16.

CRS-122
A player seeking disability benefits begins by completing a written application
and sending it to the [Retirement] Plan’s administration office in Baltimore. The
Plan office has a toll-free number that players call to ask questions and get forms,
and also has a website for downloading forms. The player is then sent to a
nearby physician approved by the Retirement Board for an examination. These
physicians are called neutral physicians and they provide a written report.
Disability claims are decided at the first level by a separate committee, the
Disability Initial Claims Committee. Since 2002 the Department of Labor has
required the existence of this separate committee. If a player is dissatisfied in
any way with the decision of the Committee, he has the right to appeal to the full
Retirement Board. Players who appeal are sent to a different second Neutral
Physician, as required by federal law. If a player is dissatisfied in any way with
the decision of the Retirement Board, he has the right to file suit in federal
court.372
Eliminating one level of review — specifically, the DICC — might affect the overall
approval rate, which is 42%. Currently, the DICC performs the initial review, and
its approval rate is 34%. As discussed above, the second level of review (the
Retirement Board) in the current configuration appears to contribute to a higher
overall approval rate. If the DICC were eliminated, would the overall approval rate
decrease from 42%, stay the same, or increase?
Other Suggestions
Mitigation of Economic Risk. The health of active and former players
might have implications for the NFL, the NFLPA, and society as a whole. Relatively
healthy individuals and former players who, through their employment, earn
sufficient wages to support themselves and their families are less likely to need
government benefits and NFL/NFLPA-provided benefits than individuals who are
unemployed, underemployed, or suffer from chronic health problems and/or
disabilities. Dave Pear is an example of a former player who relies on government
benefits and NFL/NFLPA benefits. A former defensive lineman for the Oakland
Raiders and the Tampa Bay Buccaneers, Pear receives a $606 monthly pension
payment from the retirement plan and $2,000 per month in Social Security disability
benefits.373 Medicare has paid most of the costs of his surgeries.374
Since the injuries and medical conditions an active player sustains most likely
will have some bearing on his health in retirement, mitigation begins with active
players. (The NFL and NFLPA policies on steroids and substances of abuse are
examples of efforts to mitigate risk.375) To aid in mitigating the economic risk
372 Ibid., pp. 14-15.
373 Leahy, “The Pain Game,” p. 10.
374 Ibid.
375 National Football League and NFL Players Association, National Football League Policy
on Anabolic Steroids and Related Substances 2007; National Football League and NFL
Players Association, National Football League Policy and Program for Substances of
(continued...)

CRS-123
associated with the health and safety of players, two options are available. A neutral
party could conduct a single review, or multiple reviews, of the conditions, terms,
policies, and procedures involving player health and safety. Within the federal
government, the National Institute for Occupational Safety and Health and the
Institute of Medicine (IOM) of the National Academies are examples of two entities
that, with appropriate funding, might be able to undertake this initiative.376 Another
option for facilitating the mitigation of risk would be to have the Occupational Safety
and Health Administration (OSHA) review the working conditions of NFL players,
set and enforce standards, and provide education.377
Independent Studies. While the NFLPA has not conducted its own research
or written its own articles on medical subjects and related subjects, the NFL has
awarded grants for research, and members of the MTBI Committee, and perhaps
other NFL committees as well, have written articles on medical subjects.378 (See
Appendix B for a list of studies and articles that each entity has sponsored or
published. The recipients of NFL Charities grants for MTBI and related research are
375 (...continued)
Abuse. Substances of abuse include, for example, marijuana and cocaine. The policy also
covers the abuse of prescription drugs, over-the-counter medications, and alcohol. (Ibid., p.
1.)
376 NIOSH, which is located within the Dept. of Health and Human Services, Centers for
Disease Control, “is the federal agency responsible for conducting research and making
recommendations for the prevention of work-related injury and illness. (Dept. of Health and
Human Services, Center for Disease Control, National Institution for Occupational Safety
and Health, “About NIOSH,” available at [http://www.cdc.gov/niosh/about.html].) IOM
“provides unbiased, evidence-based, and authoritative information and advice concerning
health and science policy to policy-makers, professionals, leaders in every sector of society,
and the public at large.” (Institute of Medicine, “About,” available at [http://www.iom.edu/
CMS/AboutIOM.aspx].)
377 OSHA, which is part of the Dept. of Labor, “aims to ensure employee safety and health
in the United States by working with employers and employees to create better working
environments.” (Dept. of Labor, Occupational Safety and Health Administration, “OSHA
Facts — August 2007,” available at [http://www.osha.gov/as/opa/oshafacts.html].)
378 Although the NFL has referred to the MTBI Committee as “the NFL’s independent
committee on mild-traumatic brain injury,” and has noted that the “MTBI Committee will
continue to operate as an independent group,” it is unclear what is meant by “independent”
in these statements. (National Football League, “NFL Outlines Standards for Concussion
Management,” news release, May 22, 2007, p. 1.) The degree of independence might
depend upon, for example, the terms and conditions governing members’ service on the
committee; whether committee members are compensated in any way for their service; and
whether any other committee, office, or individual in or affiliated with the NFL conducts
a pre-publication review of articles produced by committee members. At the conclusion of
at least one of the articles published by members of the MTBI Committee is a statement that
disavows any conflict of interest. The text of the statement is as follows: “None of the
Committee members have a financial or business relationship posing a conflict of interest
to the research conducted on concussion in professional football. Funding for this research
was provided by the National Football League and NFL Charities. The Charities is funded
by the NFL Players’ Association and League.” (Pellman, et al., “Concussion in Professional
Football: Players Returning To the Same Game — Part 7,” p. 90.)

CRS-124
shown in Table 17.) Selecting individuals and organizations that are not affiliated,
either directly or indirectly, with the NFL to conduct research on subjects and issues
related to player health might provide a fresh perspective while helping to alter the
perception, if not the reality, that, as some observers allege, the NFL uses its own
research “to justify league practices.”379 The National Institute of Occupational
Safety and Health (NIOSH) and the Center for the Study of Retired Athletes (CSRA),
University of North Carolina at Chapel Hill, are two organizations that are
independent of the NFL and the NFLPA and may have the capability to conduct
studies of active and former NFL players.380 In the early 1990s, the NFLPA asked
NIOSH to conduct a mortality study to “investigate the rate and causes of death of
National Football League Players.”381 Additionally, as noted above, Dr. Bennet I.
Omalu and his co-authors offered to “collaborate with the Mild Traumatic Brain
Injury Committee and the NFL in developing and implementing an optimal research
program that will address these newly emerging issues.”382
Data: Collection, Quality, and Access. The collection, analysis, and
reporting of certain data might serve a number of purposes, such as providing
additional, or more complete, information to active players about injuries and
possible long-term consequences, and helping the NFL, the NFLPA, and the
retirement plan office to identify and remedy possible problems associated with the
administration of benefits. Possible options include providing injury surveillance
system reports to active players, which could aid them in understanding, for example,
the scope and frequency of injuries, which positions are at risk for certain injuries,
and why certain protective equipment or safety procedures are necessary for players’
safety. Provision of the data (in addition to the two reports that are produced each
season) to the NFLPA would make it possible for the players association to conduct
its own analysis of injuries.
Suggestions for new data collection efforts include conducting exit interviews
with players who are retiring, carrying out a survey of former players, and
establishing and maintaining a database on the disposition of applications for
disability benefits. Exit interviews might provide information useful to the league,
the players association, and the players themselves. An exit interview could cover
a range of topics including, for example, reason(s) for retirement, feedback on the
nature and quality of health care received as a player, a discussion of health and
safety issues (including the player’s narrative of injuries sustained), and retirement
379 Peter Keating, “See No Evil? The NFL Won’t Face Concussion Facts,” ESPN.com, Jan.
19, 2007, available at [http://sports.espn.go.com/nfl/columns/story?id=2736505].
380 Information about NIOSH and CSRA is available at [http://www.cdc.gov/niosh/] and
[http://www.csra.unc.edu/], respectively.
381 Letter from Baron and Rinsky to Woschitz, p. 1.
382 Omalu, et al., “Chronic Traumatic Encephalopathy in a National Football League
Player,” May 2006, p. E1003. According to a 2000 news article, the NFLPA had tried to
get the NFL to join the players association in asking the Centers for Disease Control to
conduct a “comprehensive injury study,” but the NFL was not interested. The NFL
apparently responded that no such offer had been made by the players association.
(Gutierrez, “NFL Injuries; Pain Game.”)

CRS-125
plans.383 One or more surveys of former players could be used to gather information
about their health and employment status, and could aid in determining how well
existing benefits meet active and retired players’ needs. Benefit program evaluation
efforts also might be enhanced by a survey of retired players. Considering that the
disposition of applications for disability benefits is a sensitive issue,384 detailed,
information that shows how many applications were denied, and why, at each step
of the LOD application process and at each step of the T&P application process
might be useful in explaining how the application process works and why
applications were denied.
Ensuring that the information gleaned from the initiatives described above is
provided to, at a minimum, active players, former players, the NFL, and the NFLPA
could yield several advantages. Active and former players would be better informed
about a number of subjects and issues related to health, safety, and benefits; the NFL,
the NFLPA, and the retirement plan office would receive feedback about benefits and
the administration of benefits; and NFL and NFLPA personnel who deal with health
and safety issues would receive potentially significant information about the medical
treatment of players, and the health of two groups of former players — those who
have just concluded their NFL careers and those who have been retired for a number
of years. Additionally, an overarching benefit could be enhanced accountability and
transparency as all of the stakeholders would have access to the same information.
The actual benefits of such initiatives, and the validity and reliability of the data
collected, would depend upon a number of factors, such as the way in which
383 An exit physical examination might be useful, too, to both the player and the team. The
player would have complete documentation of his health, including neurological health,
upon the conclusion of his NFL career, and the information could be submitted to the NFL’s
injury surveillance system, which then might aid in tracking the long-term effects of injuries,
if any. NFL teams are responsible for the cost of medical services provided by team
physicians. Having team physicians conduct exit physical examinations might increase the
cost of such services to the team. A player might be hesitant to submit to an exit
examination if the results could possibly affect his ability to purchase health insurance at
a reasonable price after the health insurance provided by the NFL and NFLPA expired.
Additionally, although an active or former player may request a copy of his medical records
and trainer’s records during the off-season, perhaps a copy of both sets of records could be
provided automatically to a player upon his retirement. (National Football League and NFL
Players Association, NFL Collective Bargaining Agreement, 2006-2012, p. 199.) Under
Article XLIV, “Players’ Right to Medical Care and Treatment,” of the CBA, each player is
required to undergo a standard minimum pre-season physical examination. The protocol for
standard minimum pre-season physical examination, which includes the following, might
serve as a model for an exit examination: general medical examination, orthopedic
examination, flexibility, EKG, stress test (at physician’s discretion), blood test, urinalysis,
vision test, hearing test, dental examination, chest x-ray (at appropriate intervals), and x-ray
of all previously injured areas. (Ibid., pp. 197, 279-281.)
384 U.S. Congress, House Committee on the Judiciary, Subcommittee on Commercial and
Administrative Law, The National Football League’s System for Compensating Retired
Players: An Uneven Playing Field? statement of Douglas W. Ell; letter from Douglas W.
Ell, to Rep. Linda Sanchez, Chair, Subcommittee on Commercial and Administrative Law,
July 3, 2007; and U.S. Congress, Senate Committee on Commerce, Science, and
Transportation, Oversight of the NFL Retirement System, unpublished transcript, 110th
Cong., 1st sess., Sept. 18, 2007.

CRS-126
information was collected, how respondents were selected, and how survey questions
were worded.
Establish an Ombudsman Office. Although the NFLPA does not
represent former players, the organization has a Retired Players Department, which
“acts to meet players’ needs with the right services; continuously communicates and
involves players of all ages to create an exclusive fraternity; works collaboratively
with other NFLPA departments and Players Inc to give outstanding value to its
members; provides leadership, administration, coordination and implementation to
serve the needs of retired players and retired player chapters.”385 Active players are
represented by the players association, and they select the members of the NFLPA’s
Board of Player Representatives. (Members of each team elect a player
representative and an alternate player representative. Both serve on the Board of
Player Representatives.386)
Additional options for involving current and former players in issues of interest
to them and for identifying and addressing problems include expanding the
membership of each committee involved in health and safety issues and establishing
one or more ombudsmen. Opening up committee membership to active players
would promote participation by the individuals who have a direct stake in the work
of the committees. Furthermore, players might bring a fresh perspective and
innovative ideas to the work of each committee. Expanding committee membership
in this way might not be feasible, however. Player-members might find it difficult
to attend meetings that are held during the season, and their contributions might be
limited during discussions that require specialized knowledge. Establishing an
ombudsman office in one or more of the following organizations — the NFL,
NFLPA, and retirement plan office — would provide an outlet for active and/or
former players. In addition to responding to complaints and requests for assistance,
an ombudsman office could function akin to an auditor or a government inspector
general, identifying and examining issues and problems. Planning for the
establishment of an ombudsman office would probably have to address, at a
minimum, funding, organizational independence, and the culture of the organization
in which it is to be located.
Concluding Observations
Professional football is an immensely popular sport in the United States, yet it
exacts a physical toll on the men who play the game. Injuries and health problems
sustained by active players run the gamut from sprained knees and ankles to
concussions and broken bones, and injuries might have long-term consequences for
a player’s health. It has been suggested by several studies, for example, that mild
traumatic brain injuries might lead to depression or Alzheimer’s-like disease. The
NFL and the NFLPA, through collective bargaining and other discussions, have
385 NFL Players Association, “Retired Players Department: FAQs,” p. 1.
386 NFL Players Association, “FAQs,” n.d., available at [http://www.nflplayers.com/user/
template.aspx?fmid=181&lmid=237&pid=0&type=c#a1].

CRS-127
created a variety of benefits for retired and active players, including benefits for
individuals who are totally and permanently disabled. Additionally, the league has
established several committees that deal with health and safety issues, and the players
association has its own medical advisor. Organizations not affiliated with the NFL
or the players association also have taken steps to provide assistance to former
players.
The subject of players’ injuries, disabilities, and benefits is a complex one, and,
accordingly, there are a host of issues surrounding this subject. Although the number
and type of benefits have grown over the years, older retirees, particularly those who
played prior to 1982, have fewer benefits available to them than their successors
have. Yet, this subset of former players might have the greatest financial and medical
needs. MTBI research has been a somewhat controversial issue, because some
experts have published articles whose findings do not agree with those of the NFL’s
MTBI Committee. These issues, and the others discussed above, suggest that there
may not be any simple or easy answers to the health problems experienced by active
and former players, or to the questions raised about the sufficiency of benefits for
retirees in particular. The players association has suggested three legislative options,
and it might be possible, for example, to mitigate the risk of playing professional
football and to gather data that could be used to educate players, improve the
administration of existing benefits programs, and determine the extent of former
players’ needs.

CRS-128
Appendix A. Glossary
Active Player — “A Player who is obligated to perform football playing services
under a contract with an Employer; provided, however, that for purposes of Section
5.1 only, Active Player will also include a Player who is no longer obligated to
perform football playing services under a contract with an Employer, but is between
the period beginning when his last such contract expired or was terminated for any
reason, and ending on the later of (a) the July 15 following the beginning of the
period, or (b) the first day of preseason training camp.”387
Affiliate — “means, with respect to a particular Employer, (a) any corporation, other
than the Employer, which is a member of a controlled group of corporations (within
the meaning of [Internal Revenue] Code [of 1986, as amended] section 414(b) of
which such Employer is a member, (b) any trade or business, other than the
Employer, which together with such Employer are under common control (within the
meaning of [Internal Revenue] Code section 414(c)), (c) any employer, other than the
Employer, which is a member of an affiliated service group (within the meaning of
[Internal Revenue] Code section 414(m)) of which such Employer is a member, and
(d) any other entity required to be aggregated with the Employer under section 414(o)
of the [Internal Revenue] Code.”388
Annuity Year — The 12-month period beginning April 1 and ending March 31 of
the following year.389
Arising out of League football activities — This means “a disablement arising out
of any League pre-season, regular-season, or post-season game, or any combination
thereof, or out of League football activity supervised by an Employer, including all
required or directed activities. [This phrase] does not include, without limitation, any
disablement resulting from other employment, or athletic activity for recreational
purposes, nor does it include a disablement that would not qualify for benefits but for
an injury (or injuries) or illness that arises out of other than League football
activities.”390
Benefit credit — “means the credit in Section 4.1 [of the Retirement Plan] for the
corresponding Credited Season.”391
Credited season — “[A] Plan Year in which a Player: (a) is an Active Player
(including an injured Player who otherwise satisfies the definition of ‘Active Player’)
on the date of three or more Games, not including Game dates when he was on the
Future List; (b) after April 1, 1970, is injured in the course and scope of his
387 Bert Bell/Pete Rozelle NFL Player Retirement Plan, p. 2.
388 Ibid.
389 Information provided telephonically by Benjamin L. Zelenko , Esq., to the author on Dec.
10, 2007.
390 Bert Bell/Pete Rozelle NFL Player Retirement Plan, p. 26.
391 Ibid., pp. 2-3.

CRS-129
employment for an Employer and by reason of such injury receives payment
equivalent to his salary for three or more Games or for a number of Games which,
when added to the number of Games in such Plan Year for which he otherwise has
credit, totals three or more; (c) after reporting to at least one official pre-season
training camp or official practice session during such Plan Year, (1) dies, (2)
becomes totally and permanently disabled under Section 5.1(a) [active football] or
Section 5.1(b) [active nonfootball], or (3) incurs a disability that subsequently
qualifies for a benefit under Section 6.1 [line-of-duty disability]; (d) is absent from
employment by an Employer while serving in the Armed Forces of the United States,
provided such Player returns as an Active Player, after first being eligible for
discharge from military service, by the later of (i) 90 days or any longer period
prescribed by applicable law, or (ii) the opening of the official pre-season training
camp; (e) effective June 1, 2003, was absent from employment by an Employer while
serving in the Armed Forces of the United States during the periods set forth in the
table below [the periods cover World War II, the Korean War, and the Vietnam War]
if (1) during the one year period ending on the date he entered the Armed Forces,
such Player either played professional football for an Employer or signed a contract
(or a similar document) stipulating his intent to play professional football for an
Employer, and (2) such Player was alive on the date set forth in the table below for
the corresponding period ... provided that Credited Seasons under this Section 1.10(e)
[definition of “credited season”] will be granted only if and to the extent necessary
for such Player to become a Vested Player; or (f) effective April 1, 2001, has a season
with at least eight games on the practice squad in a Plan Year (either before or after
April 1, 2001) in which he did not otherwise earn a Credited Season, provided that
he is otherwise vested and earns a Credited Seasons in 2001 or later. A player may
earn a maximum of one Credited Season under this Section 1.10(f) regardless of the
number of seasons in which he has at least eight games.”392
Disability Initial Claims Committee (DICC) — This committee, which has two
members (one is appointed by the NFLPA, the other by the NFL Management
Council), is “responsible for deciding all initial claims for any and all disability
benefits under [the Retirement] Plan. The Disability Initial Claims Committee also
will make initial decisions under Sections 5.3 [total and permanent disability] and 6.3
[line-of-duty disability] as to whether Players currently receiving disability benefits
should continue to receive those benefits. At the request of a member of the
Disability Initial Claims Committee, the Disability Initial Claims Committee will
reconsider any decision it has made. When making the decisions described in this
[section], the Disability Initial Claims Committee will have full and absolute
discretion, authority and power to interpret the Plan and the Trust.”393
Employee — “[A]n individual who (a) is employed by an Employer as an Active
Player, or (b) is employed by an Employer or an Affiliate in a capacity other than as
392 Ibid., pp. 3-4.
393 Ibid., pp. 31-32.

CRS-130
an Active Player (provided that such employment immediately precedes or
immediately follows, without interruption, employment as an Active Player).”394
Employer — “A member club of the League.”395
Final League Year — is “the League Year which is scheduled prior to its
commencement to be the final League Year of the Collective Bargaining
Agreement.”396
Inactive vested player — See “vested inactive player.”
League Year — is “the period from February 20 of one year through and including
February 19 of the following year, or such other one year period to which the NFLPA
and the [NFL’s] Management Council may agree.”397
Life only pension — “Equal monthly pension payments payable during the Player’s
lifetime only.”398
Line of Duty Disability — “Any player who incurs a ‘substantial disablement’ (as
defined in Section 6.4(a) and (b) [of the Bert Bell/Pete Rozelle NFL Player
Retirement Plan]) ‘arising out of League football activities’ (as defined in Section
6.4(c) [of the
Bert Bell/Pete Rozelle NFL Player Retirement Plan]) will receive a monthly line-of-
duty disability benefit ....399“
Normal retirement date — “[T]he first day of the calendar month coincident with
or next following a Player’s 55th birthday.”400
Plan Year — “[A] 12-month period from April 1 to March 31. A Plan Year is
identified by the calendar year in which it begins.”401
Player — “Any person who is or was employed under a contract by an Employer to
play football in the League and who is or was (a) on the Active List or the Inactive
List (as such lists are or have been defined in the Constitution and By-Laws of the
League) of an Employer; (b) on an Employer’s roster without being on the Active
List by reason of injuries sustained in the Chicago Tribune All-Star Game; (c) injured
in the course and scope of his employment for an Employer and by reason of such
394 Ibid., p. 4.
395 Ibid.
396 Ibid.
397 Ibid., p. 6.
398 Ibid., p. 13.
399 Ibid., p. 25.
400 Ibid., p. 6.
401 Ibid.

CRS-131
injury paid under such contract for all or part of the Plan Year in which the injury
occurs or occurred; (d) on the Move List, or, for the purposes of the benefits provided
by Articles 5, 6 and 7, on the Future List of an Employer after April 1, 1970 (as such
lists have been defined in the Constitution and By-Laws of the League); or (e) on the
Reserve/Physically Unable to Perform or the Reserve/NFI-EL Lists of an Employer
(as such lists have been defined in the Constitution and By-Laws of the League).”402
Pre-59ers — The first pension plan, the Bert Bell NFL Player Retirement Plan, was
established in 1962, but it was retrospective to only 1959. Players who left football
before 1959 — the pre-59ers — were not covered by this plan.403
Projected total revenues — “[T]he amount of Benefits projected in accordance with
the rules set forth in Article XXIV [of the CBA] (Guaranteed League-wide Salary,
Salary Cap & Minimum Team Salary.”404
Qualified joint and survivor annuity — “[A] monthly annuity for the life of the
Player with a monthly survivor annuity for the life of the Spouse equal to 50% of the
amount of the monthly annuity payable during the life of the Player, which benefit
will be the Actuarial Equivalent of the life only pension form of benefit ....”405
Retired player — same as former or inactive player. NFL and NFLPA documents
define “active player” and the implication is that an individual who does not fall into
the active category is inactive.
Retirement Board — “The Retirement Board will be the ‘named fiduciary’ of the
[Retirement] Plan within the meaning of section 402(a)(2) of ERISA [Employee
Retirement Income Security Act], and will be responsible for implementing and
administering the Plan, subject to the terms of the Plan and Trust. The Retirement
Board will have full and absolute discretion, authority, and power to interpret,
control, implement, and manage the Plan and the Trust.”406
Salary cap — “[T]he absolute maximum amount of Salary that each Club may pay
or be obligated to pay or provide to players or Player Affiliates, or may pay or be
obligated to pay to third parties at the request of and for the benefit of Players or
Player Affiliates, at any time during a particular League Year, in accordance with the
rules set forth in Article XXIV (Guaranteed League-wide Salary, Salary Cap &
Minimum Team Salary), if applicable.”407
402 Ibid.
403 NFL Players Association, “History of Retirement and T&P Benefits for NFL Players,”
p. 1.
404 National Football League and NFL Players Association, NFL Collective Bargaining
Agreement, 2006-2012, p. 7.
405 Bert Bell/Pete Rozelle NFL Player Retirement Plan, p. 13.
406 Ibid., pp. 29-30.
407 National Football League and NFL Players Association, NFL Collective Bargaining
(continued...)

CRS-132
Substantial disablement — “(a) For applications received on or after May 1, 2002,
a ‘substantial disablement’ is a ‘permanent” disability that: (1) Results in a 50% or
greater loss of speech or sight; or (2) Results in a 55% or greater loss of hearing; or
(3) Is the primary or contributory cause of the surgical removal or major functional
impairment of a vital bodily organ or part of the central nervous system; or (4) For
orthopedic impairments, using the American Medical Association Guides to the
Evaluation of Permanent Impairment (Fifth Edition, Chicago IL) (‘AMA Guides’),
is (a) a 38% or greater loss of use of the entire lower extremity; (b) a 23% or greater
loss of use of the entire upper extremity; (c) an impairment to the cervical or thoracic
spine that results in a 25% or greater whole body impairment; (d) an impairment to
the lumbar spine that results in a 20% or greater whole body impairment; or (e) any
combination of lower extremity, upper extremity, and spine impairments that results
in a 25% or greater whole body impairment. In accordance with the AMA Guides,
up to three percentage points may be added for excess pain in each category above
((a) through (e)). The range of motion test will not be used to evaluate spine
impairments. (b) A disability will be deemed to be ‘permanent’ if it has persisted or
is expected to persist for at least 12 months from the date of its occurrence and if the
Player is not an Active Player.”408
Totally and permanently disabled409 — “An Active Player or a Vested Inactive
Player, other than a Player who has reached his Normal Retirement Date [age 55] or
begun receiving his monthly pension under Article 4 [Retirement Benefits], will be
deemed to be totally and permanently disabled if the Retirement Board or the
Disability Initial Claims Committee finds that he has become totally disabled to the
extent that he is substantially prevented from or substantially unable to engage in any
occupation or employment for remuneration or profit, but expressly excluding any
disability suffered while in the military service of any country. A Player will not be
considered to be able to engage in any occupation or employment for remuneration
or profit within the meaning of this Section 5.2410 merely because such person is
employed by the League or an Employer, manages personal or family investments,
is employed by or associated with a charitable organization, or is employed out of
benevolence.”411
Vested player — A player who: “(a) earns five Credited Seasons; (b) earns four
Credited Seasons, including a Credited Season after the 1973 Plan Year; (c) earns
three Credited Seasons, including a Credited Season after the 1992 Plan Year; (d)
407 (...continued)
Agreement, 2006-2012, p. 7.
408 Bert Bell/Pete Rozelle NFL Player Retirement Plan, p. 26.
409 A definition of “permanent disability” may be found in Article 6, “Line-of-Duty
Disability,” of the Bert Bell/Pete Rozelle NFL Player Retirement Plan: “A disability will
be deemed ‘permanent’ if it has persisted or is expected to persist for at least 12 months
from the date of its occurrence and if the Player is not an Active Player.” (Ibid., p. 26.) It
is unclear whether this definition also applies to the determination of total and permanent
disabilities made by the Retirement Board and the Disability Initial Claims Committee.
410 This definition is the text of Section 5.2.
411 Bert Bell/Pete Rozelle NFL Player Retirement Plan, p. 21.

CRS-133
after the 1975 Plan Year, is an Employee on his Normal Retirement Date; (e) after
receiving total and permanent disability benefits under Article 5 [of the retirement
plan], is found to no longer qualify for total and permanent disability; (f) is an
Employee after the 1975 Plan year and has at least 10 Years of Service (only for the
purpose of applying Article 4 [of the retirement plan] or Section 7.3 [of the
retirement plan] and not for any other purpose); (g) is an Employee after the 1988
Plan Year and has at least four Years of Service, at least one of which occurred after
the 1988 Plan Year and is a Plan Year in which the Employee did not earn a Credited
Season (only for the purpose of applying Article 4 [of the retirement plan] or Section
7.3 [of the retirement plan] and not for any other purpose); (h) is an Employee after
the 1992 Plan year and has at least three Years of Service, at least one of which
occurred after the 1992 Plan Year and is a Plan Year in which the Employee did not
earn a Credited Season (only for the purpose of applying Article 4 [of the retirement
plan] or Section 7.3 [of the retirement plan] and not for any other purpose); or (i) (1)
earned at least four (4) Credited Seasons, the last of which is earned prior to the 1974
Plan Year, and (2) is alive on June 1, 1998 (only for the purpose of applying Article
4 [of the retirement plan] or Section 7.3 [of the retirement plan] and not for any other
purpose).412
Vested inactive player — “A Vested Player who is not an Active Player.”
412 Ibid., p. 7.

CRS-134
Appendix B. NFL and NFLPA Studies Concerning
Players’ Health
The following information was provided by the NFL and the NFLPA, except for
the first item in the list. The study sponsor, participant, or author (for example, the
MTBI Committee) is identified following the citation.
Letter from Sherry Baron, M.D., M.P.H., and Robert Rinsky, U.S. Department of
Health and Human Services, National Institute for Occupational Safety and
Health, to Frank Woschitz, National Football League Players Association, Jan.
10, 1994.413 (NFLPA)
Ira R. Casson, Elliot J. Pellman, and David C. Viano, “Chronic Traumatic
Encephalopathy in a National Football League Player,” Neurosurgery, Nov.
2006, pp. 1182-1184. (MTBI Committee)
Kevin M. Guskiewicz, et al., “Recurrent Concussion and Risk of Depression in
Retired Professional Football Players,” 2006. (NFLPA)414
Elliot J. Pellman, “Background on the National Football League’s Research on
Concussion in Professional Football,” Neurosurgery, Oct. 2003, pp. 797-
798.(MTBI Committee)
Elliot J. Pellman, et al., “Concussion in Professional Football: Reconstruction of
Game Impacts and Injuries,” Neurosurgery, Oct. 2003, pp. 799-814. (MTBI
Committee)
Elliot J. Pellman, et al., “Concussion in Professional Football: Location and
Direction of Helmet Impacts — Part 2,” Neurosurgery, Dec. 2003, pp. 1328-
1341. (MTBI Committee)
Elliot J. Pellman, et al., “Concussion in Professional Football: Epidemiological
Features of Game Injuries and Review of the Literature — Part 3,”
Neurosurgery, Jan. 2004, pp. 81-96. (MTBI Committee)
Elliot J. Pellman, et al., “Concussion in Professional Football: Repeat Injuries — Part
4,” Neurosurgery, Oct. 2004, pp. 860-876. (MTBI Committee)
413 This study was published as correspondence, and the letter notes that the mortality study
was conducted at the request of the NFL Players Association. This document is popularly
known as the “NFL mortality study.”
414 Guskiewicz, et al., did not publish an article in 2006. The information from the NFLPA
appears to be a reference to this article: Kevin M. Guskiewicz, et al., “Recurrent Concussion
and Risk of Depression in Retired Professional Football Players,” Medicine and Science in
Sports and Exercise, June 2007, pp. 903-909.

CRS-135
Elliot J. Pellman, et al., “Concussion in Professional Football: Injuries Involving 7
or More Days Out — Part 5,” Neurosurgery, Nov. 2004, pp. 1100-1119. (MTBI
Committee)
Elliot J. Pellman, et al., “Concussion in Professional Football: Neuropsychological
Testing — Part 6,” Neurosurgery, Dec. 2004, pp. 1290-1305. (MTBI
Committee)
Elliot J. Pellman, et al., “Concussion in Professional Football: Players Returning to
the Same Game — Part 7,” Neurosurgery, Jan. 2005, pp. 79-92. (MTBI
Committee)
Elliot J. Pellman, et al., “Concussion in Professional Football: Helmet Testing to
Assess Impact Performance — Part 11,” Neurosurgery, Jan. 2006, pp. 78-96.
(MTBI Committee)
Elliot J. Pellman, et al., “Concussion in Professional Football: Recovery of NFL and
High School Athletes Assessed by Computerized Neuropsychological Testing
— Part 12,” Neurosurgery, Feb. 2006, pp. 263-274. (MTBI Committee)
Elliot J. Pellman and David C. Viano, “Concussion in Professional Football,”
Neurosurgical Focus, Oct. 2006, pp. 1-10. (MTBI Committee)
Beverly Pitts, “After the Battle: Report on Lives of Former Players,” May 1994.
(NFLPA)
Beverly Pitts, “A Study of Players Who Left Professional Football in the 90’s,” June
2002. (NFLPA)
Mark Popovich and Beverly Pitts, “Life After Football: A Survey of Former Players”
May 1989. (NFLPA)
Mark Popovich and Beverly Pitts, “Aftermath of an NFL Career: Injuries.” (NFLPA)
May 1990
Mark Popovich and Beverly Pitts, “Lifestyle After Football,” Spring 1994. (NFLPA)
Mark Popovich and Beverly Pitts, “Life After Football: Careers and Opportunities,”
Sept. 1996. (NFLPA)
Arthur Roberts, “Determinants of Cardiovascular and Respiratory Risk in Elite
Professional Football Players,” 2004. (NFLPA)
Thomas Schwenk, et al., “Depression and Pain in Retired Professional Football
Players,” n.d. (NFLPA)
Paul Tagliabue, “Tackling Concussions in Sports,” Neurosurgery, Oct. 2003, p. 796.
(NFL)

CRS-136
David C. Viano, “Report on ProCap Helmet Tests at Biokinetics,” Jan. 17, 2002.
(MTBI Committee)415
David C. Viano and Elliot J. Pellman, “Concussion in Professional Football:
Biomechanics of the Striking Player — Part 8,” Neurosurgery, Feb. 2005, pp.
266-280. (MTBI Committee)
David C. Viano, et al., “Concussion in Professional Football: Brain Responses by
Finite Element Analysis: Part 9,” Neurosurgery, Nov. 2005, pp. 891-916.
(MTBI Committee)
David C. Viano, et al., “Concussion in Professional Football: Comparison with
Boxing Head Impacts,” Neurosurgery, Dec. 2005, pp. 1154-1172. (MTBI
Committee)
David C. Viano, et al., “Concussion in Professional Football: Performance of Newer
Helmets in Reconstructed Game Impacts — Part 13,” Neurosurgery, Sept.
2006, pp. 591-606. (MTBI Committee)
David C. Viano, Ira R. Casson, and Elliot J. Pellman, “Concussion in Professional
Football: Biomechanics of the Struck Player — Part 14,” Neurosurgery, Aug.
2007, pp. 313-328. (MTBI Committee)
Planned or Ongoing Studies
In 2007, the NFL stated that studies are in progress or planned for the following
subjects (the organization(s) conducting the study or studies are also listed):
! Protective effects of mouthguards, by Biokinetics and Associates,
Ltd.416
! Biomechanical [research], Wayne State University and the
University of Göteborg (Sweden).
! Long-term effects of concussions. The organization(s) conducting
this study were not identified, although it was noted that “[d]ifferent
phases of the study are being managed by different researchers.”417
415 This article was not published.
416 Biokinetics and Associates, Ltd., is a Canadian firm that, according to its mission
statement, “provides engineered solutions to human impact protection for sports,
transportation and defence/law enforcement appplications.” (Biokinetics, “Mission,”
available at [http://www.biokinetics. com/profile_index.html].)
417 In a New York Times article dated May 31, 2007, it was reported that the Commissioner
of the NFL had said that the MTBI Committee “had just begun its own study ‘to determine
if there are any long-term effects of concussions on retired N.F.L. players.’ Dr. Casson, the
committee’s co-chair, said that players who retired from 1986 through 1996 would be
(continued...)

CRS-137
! Cardiovascular health of active players, NFL’s Cardiovascular
Health Committee.418
417 (...continued)
randomly approached to undergo ‘a comprehensive neurological examination, and a
comprehensive neurologic history, including a detailed concussion history,’ using player
recollection cross-referenced with old team injury reports. He said that the study would take
two to three years to be completed and another year to be published.” (Alan Schwarz,
“Study of Ex-N.F.L. Players Ties Concussion to Depression Risk,” New York Times, May
31, 2007, p. C18.) It is possible that this excerpt refers to the same study that the NFL
mentioned in its letter to the House Committee on the Judiciary, which is the source for the
studies included in this list. Team injury reports may not include all of the concussions that
a player experienced, for reasons discussed above regarding financial incentives that may
cause a player not to report an injury.
418 Letter from Goodell to Reps. Conyers and Smith, pp. 3-4.

CRS-138
Appendix C. Members of the Mild Traumatic Brain
Injury Committee and Retired Player Study
Investigators
The following information is current as of October 30, 2007. The position or
role that each individual has or fills on the committee is listed first in each entry,
following the individual’s name and academic degree(s) or certification. Eight
committee members are employed by NFL teams; the team is included in the list of
each individual’s professional affiliations.419
MTBI Committee
David Viano, M.D., Ph.D. — Co-chair and biomedical engineer; Biomedical
Engineer, ProBiomechanics LLC; Adjunct Professor of Engineering, Wayne State
University.
Ira Casson, M.D. — Co-chair and neurologist; Assistant Professor of Neurology,
Albert Einstein School of Medicine and Long Island Jewish Medical Center.
Ronnie Barnes, ATC — Head athletic trainer, New York Giants.420
Rick Burkholder, ATC — Head athletic trainer, Philadelphia Eagles.
Henry Feuer, M.D. — Neurosurgeon; Neurosurgeon, Indiana University Medical
Center and Indianapolis Neurosurgical Group; Indianapolis Colts.
Mark Lovell, Ph.D. — Neuropsychologist; Director, University of Pittsburgh
Medical Center (UPMC) Sports Concussion Program; Associate Professor of
Neurological Surgery, University of Pittsburgh.421
419 Unless noted otherwise, the sources of information in this appendix are National Football
League, “NFL Outlines Standards for Concussion Management,” n.d., pp. 4-5; National
Football League, “NFL Subcommittee on Mild Traumatic Brain Injury Membership and
Affiliations As of October 30, 2007,” n.d.
420 ATC is the acronym for “certified athletic trainer.” (National Athletic Trainers
Association, “The Facts about Certified Athletic Trainers and the National Athletic Trainers
A s s o c i a t i o n , ” a v a i l a b l e a t [ h t t p : / / w w w . n a t a . o r g / c o n s u m e r / d o c s /
Factsaboutathletictrainers.pdf].)
421 Mark Lovell also is the Chairman and Software Developer, ImPACT Applications, Inc.,
which sells neurocognitive testing software to NFL teams. (ImPACT Applications,
“Developers/Clinical,” available at [http://www.impacttest.com/contact.php#anc1];
ImPACT Applications, Inc., “Professional Teams,” available at [http://www.impacttest.com/
currentusers.php?type=proteam].) For additional information on ImPACT, see Peter
Keating, “NFL’s Concussion Expert Also Sells Equipment to League,” ESPN.com, Aug. 10,
2007, available at [http://sports.espn.go.com/nfl/news/story?id=2967678].

CRS-139
Joseph Maroon, M.D. — Neurosurgeon; Neurosurgeon, UPMC; Clinical Professor
and Vice Chairman, Department of Neurological Surgery, University of Pittsburgh
School of Medicine; Pittsburgh Steelers.422
Joel Morgenlander, M.D. — Neurologist; Professor of Neurology, Duke University
Medical Center.
Thomas Naidich, M.D. — Neuroradiologist; Professor and Chief of Neuroradiology,
Mount Sinai School of Medicine.
Elliot Pellman, M.D. — NFL Medical Liaison; Member, NFL Injury and Safety
Panel, NFL Subcommittee on Cardiovascular Health, and NFL Foot and Ankle
Subcommittee; Medical Director, ProHEALTH Care Associates; Associate Clinical
Professor of Medicine and Orthopedics, Mount Sinai School of Medicine; New York
Jets.
John Powell, Ph.D., ATC — Epidemiologist; NFL Consultant, Injury Studies, Med
Sports Systems; Associate Professor, Departments of Kinesiology and Physical
Medicine and Rehabilitation, Michigan State University.
Doug Robertson, M.D. — Sports medicine; Indianapolis Colts.
Andrew Tucker, M.D. — Sports medicine; Co-Chairman, NFL Subcommittee on
Cardiovascular Health; Member, NFL Injury and Safety Panel; Chief of Sports
Medicine, Union Memorial Hospital; Baltimore Ravens.
Joe Waeckerle, M.D. — Emergency medicine; Editor Emeritus, Annals of
Emergency Medicine; Clinical Professor of Medicine, University of Missouri School
of Medicine; Kansas City Chiefs.
Retired Player Study Investigators
The professional affiliations of investigators who are also members of the MTBI
Committee may be found above.
Ira Casson, M.D. — Member of MTBI Committee.
422 Information about Joseph Maroon’s employment with the Pittsburgh Steelers came from
University of Pittsburgh Medical Center, “Joseph C. Maroon, M.D.,” available at
[http://www.upmc.com/Communications/MediaRelations/UPMCExperts/ByName/M/
MaroonJosephC.htm]. Joseph Maroon also is the Chief Medical Officer, ImPACT
Applications, Inc., which sells neurocognitive testing software to NFL teams. (ImPACT
Applications, “Developers/Clinical,” available at [http://www.impacttest.com/
contact.php#anc1]; ImPACT Applications, Inc., “Professional Teams,” available at
[http://www.impacttest.com/currentusers.php?type=proteam].) For additional information
on ImPACT, see Peter Keating, “NFL’s Concussion Expert Also Sells Equipment to
League,” ESPN.com, Aug. 10, 2007, available at [http://sports.espn.go.com/nfl/news/story?
id=2967678].

CRS-140
Kathleen Finzel, M.D. — Chief of Radiology, ProHEALTH Care Associates. [no
entry in parentheses for her indicating her role on the committee]
Mark Haacke, Ph.D. — Biomedical engineering; Professor of Biomedical
Engineering, Wayne State University; Director of the MRI Institute for Biomedical
Research.
Brian Hainline, M.D. — Neurologist; Associate Clinical Professor, New York
University School of Medicine; Chief of Neurology, ProHEALTH Care Associates.
Victor Haughton, M.D. — Neuroradiologist; Professor and Chief of Neuroradiology,
University of Wisconsin-Madison.
Danielle LeStrange, R.N. — Study coordinator.423
Mark Lovell, Ph.D. — Member of MTBI Committee.
Joseph Maroon, M.D. — Member of MTBI Committee.
Joe Morgenlander, M.D. — Member of MTBI Committee.
Thomas Naidich, M.D. — Member of MTBI Committee.
Elliot Pellman, M.D. — Member of MTBI Committee.
Chi-Sing Zee, M.D. — Neuroradiologist; Professor of Radiology and Director of
Neuroradiology, Keck School of Medicine, University of Southern California.
David Viano, M.D., Ph.D. — Member of MTBI Committee.
423 No information was provided about Danielle LeStrange’s professional affiliations in the
NFL’s May 22, 2007, news release.

CRS-141
Appendix D. Acronyms
CBA — collective bargaining agreement.
CTE — chronic traumatic encephalopathy.
DICC — Disability Initial Claims Committee.
LOD — line-of-duty.
MTBI — mild traumatic brain injury.
NFL — National Football League.
NFLMC — National Football League Management Council.
NFLPA — NFL Players Association.
T&P — total and permanent.