NFL Sets Higher Bar for Dementia Compensation in Black Former Players

By Linda Carroll

December 23, 2020

(Reuters Health) - The National Football League (NFL) has been unfairly depriving cognitively impaired Black players of monetary awards they would normally receive from a landmark 2013 settlement by insisting that test scores be "race-normed," according to clinical psychologists who are taking the league to task.

In a Viewpoint piece published in JAMA Neurology, Katherine Possin and her colleagues assert that the practice of "correcting" cognitive scores by race fuels the nation's "long history of structural racism and discrimination practices."

The commentary was sparked by a class action lawsuit against the NFL by two retired Black players who were denied compensation despite being diagnosed with dementia related to concussions sustained on the playing field.

"The approach the NFL is accused of taking -- requiring that race be used in the calculation to determine whether a player should receive a settlement award -- is not scientifically sound and is really inappropriate," said Possin, who holds the John Douglas French Alzheimer's Foundation Endowed Professorship at the University of California, San Francisco, Memory and Aging Center. "It perpetuates the idea that race is a biological entity. People who identify as Black are not scoring lower because of race, but rather because of social factors."

By "correcting" cognitive scores by race, the NFL perpetuates the belief that Blacks and whites are biologically different, Possin said. "The better way forward is not to correct with a crude proxy for lifelong social experience," she added.

Under the concussion settlement of 2013, the NFL agreed to pay more than $1 billion to retired football players who had suffered neurodegenerative disorders associated with repeated jolts to the brain.

Although Kevin Henry, 52, and Najeh Davenport, 41, were initially diagnosed with mild to moderate dementia related to repeated concussions by NFL-approved physicians, the league appealed and then required those physicians to rescore the players' cognitive tests implementing race-based "corrections" known as the Heaton norms. The new scores disqualified the players from getting any part of the settlement.

In essence, the Heaton norms raise the bar for diagnosing dementia in African Americans, which means that Black players will have a harder time qualifying for financial awards from the settlement.

While the initial goals in developing race based norming were positive ones -- to assure that people weren't over-diagnosed and over-treated -- their use "perpetuates the long-standing falsehood that race is a biological entity," said Robert Stern, a professor of neurology at the Boston University School of Medicine and the director of clinical research for the Boston University Chronic Traumatic Encephalopathy Center.

"It is entirely inappropriate to use them to determine financial compensation in the NFL settlement or any other purpose," Stern said. "There is a tremendous need for the development of approaches that examine and adjust for the social determinants of brain health, the variables that underlie some of the racial differences."

Stern notes that the Heaton norms were based on "a really small sample of individuals from the San Diego area only. These individuals might have been quite different from Black individuals from Chicago or Mississippi or New York. There is no such thing as a group of Black individuals who represent all Black individuals."

"The current use of race based norms assumes that a Black individual started at a lower cognitive level of functioning than a white individual," Stern said. "That would mean a Black player would require a greater impairment than a white player to qualify for financial compensation."

"For example, if there were two former players, one Black and one white, who were the same age, played the same position for the same amount of time and had identical problems with daily functioning and level of independence and had the exact same raw scores on the battery of memory and cognitive tests given for settlement evaluation, the white player would receive financial compensation and the Black player would not."

"I would hope that the settlement's special master and others overseeing the settlement would reconsider the use of race based norms and re-evaluate previous cases that have been rejected and allow for reassessment of those applications," Stern said.

SOURCE: JAMA Neurology, online December 21, 2020.