By Peter Keating
As the National Football League caps another season of record-setting viewership, revenues, and franchise values with the celebrations surrounding Super Bowl LX, former players suffering from Parkinson’s disease are facing extraordinary new hurdles when trying to get help from the NFL Concussion Settlement.
The powers managing and enforcing the NFL case – the NFL, the BrownGreer Claims Administrator in Richmond (Va.) and the lead NFL players’ lawyers – have for the last two years imposed and enforced very restrictive qualifying criteria for Parkinson’s – made public here for the first time. These criteria are based on an article about symptoms published more than a quarter of a century ago. The result of the required 27-year-old criteria, which leading Parkinson’s experts find greatly prejudices the NFL players from getting approved and paid for actual Parkinson’s, are that approvals of Parkinson’s claims are down sharply in the past year, and a large percentage of Parkinson’s claim are being held up because of use of the old criteria.
The special master overseeing the case has stated that when doctors treating retired athletes appeal adverse decisions, their letters deserve “no deference.” And the firm administering claims in the case recently launched an audit of several players’ attorneys, apparently because their clients had high rates of positive Parkinson’s diagnoses, which plaintiffs’ attorneys and Parkinson’s experts have suggested are an effort to protect the use of the old criteria.
“The NFL didn’t have a system designed to slow the payments for that particular problem, so a lot of guys were getting checks,” says Beasley Reece, a defensive back in the NFL for nine years and longtime sports commentator who was CEO of the NFL Alumni Association, an independent non-profit group supporting former NFL athletes, coaches and staff, from 2018 to 2022. “Then they figured out how to slow it way down because they don’t want the public to think that their high-school kid, if he keeps playing football, is going to have Parkinson’s disease.”
Since 2017, the NFL Concussion Settlement has made more than $1 billion in monetary awards to what is reported on the NFL case website as approximately 2,000 retired players and family members. That total is much greater than either side in the case forecast when their lawyers first crafted the arrangement, though the settlement has been plagued by charges that it has obstructed benefits. While the settlement was still taking shape, some experts objected that its coverage was incomplete, its qualifying criteria needlessly complicated, and its procedures tilted to favor the NFL. And a 2024 investigation by the Washington Post found that the settlement “routinely fails to deliver money and medical care to former players suffering from dementia and CTE.”
Until recently, those conclusions didn’t seem to apply to victims of Parkinson’s, an incurable, often crippling condition that disrupts communication between a body’s nervous system and muscles. The plaintiffs’ attorneys in the concussion lawsuit originally expected that a total of 14 Parkinson’s and 18 ALS cases would be paid $52.6 million over the 65-year lifetime of the settlement. Instead, the settlement awarded $146.5 million for 81 Parkinson’s and 30 ALS claims in just its first 18 months. At that time, the NFL said compensation was flowing so freely because cases were so clear-cut. League spokesman Brian McCarthy told the Los Angeles Times in 2018: “ALS and Parkinson’s [diagnoses] are fairly straightforward and are unlikely to trigger concerns about fraud that would slow down the processing of the claims.”
But after a few more years of high rates of applications, approvals, and awards, things changed. Special Master David Hoffman, a University of Pennsylvania Law School professor appointed by U.S. District Judge Anita Brody in 2020 to help manage and rule on the claims in the settlement, found its requirements for a qualifying diagnosis of Parkinson’s to be “sparse,” according to a ruling he issue in January 2024. He also thought the World Health Organization’s definitions, which the settlement incorporated, weren’t precise and left “much to clinical practice”—meaning the judgment and experience of doctors interacting with patients. So, even though Special Master Hoffman himself noted that the parties in the case didn’t seem to disagree about its Parkinson’s terminology, he convened a group of neurologists from the settlement’s Appeals Advisory Panel (AAP), a group that reviews claims made by players. They met in December 2023. And according to Special Master Hoffman’s ruling the following month, they wrote, and he accepted, that “the appropriate criteria for the diagnosis of Parkinson’s disease for use in the Settlement remain” something called the “Gelb criteria.”
In what has been viewed as a landmark ruling, requiring football players to now meet criteria from that original Gelb article, Special Master Hoffman ruled that he agreed with the panel that this guide to gauging Parkinson’s, published in 1999 by Douglas Gelb, a professor of neurology at the University of Michigan Medical School, constituted “the most widely used criteria in the United States at the time of the Settlement (2014).” And from the moment Hoffman wrote that he approved of the Gelb criteria, the Gelb article became the mandated and enforced as the NFL Concussion Settlement’s definition of the disease.
But Parkinson’s experts as well as historians of benchmarks for the disease agree that the Gelb criteria never caught on in a way that would make them anything like “the most widely used criteria” for PD. “The Gelb criteria summarized what they felt was the state of the art in 1999 for diagnostic criteria for Parkinson’s disease,” says William Ondo, director of the Movement Disorders Clinic at Houston Methodist Hospital, who has authored more than 300 journal articles and book chapters. “It did not include original data and the criteria were never widely used in clinical practice or research studies.”
Indeed, in a 2018 paper for Frontiers in Neurology, authors from three neurological institutes in Italy surveyed methods since 1817, when English physician James Parkinson called the disease that came to be named for him “the Shaking Palsy.” They found: “Concerning the diffusion of the different criteria … only a small number of clinical studies (mainly carried out in the US and in Scandinavia) have adopted Gelb criteria, [with] more limited diffusion among practicing clinicians.
Asked about the Gelb criteria and his rulings, Special Master Hoffman responded: “I’m sorry to say that as a judicially appointed Special Master, I’m not permitted to comment for your story on the Settlement.” The NFL did not respond to a request for comment; Neither did BrownGreer, the Richmond, Va.-based claims administrator for the settlement.
Parkinson’s specialists say there’s a bigger concern about the Gelb criteria than their popularity: their dubious worthiness as a tool for today’s doctors. The Gelb criteria focus mostly on motor symptoms, meaning problems with moving, such as tremors, bradykinesia (slowness) or stiffness. But research has revealed, and physicians now recognize, a range of other kinds of issues related to the disease—and how they can surface sooner than classic markers. “Over the last 25 years,” says Ondo, “we’ve become aware of the importance of the non-motor symptoms, including things such as dream enactment behavior [compulsively acting out dreams while sleeping], loss of sense of smell, and constipation.”
“The Gelb criteria’s requirements reject some persons who otherwise very likely have the earliest manifestations of PD, and so these criteria are excessively exclusionary,” says Dr. Peter LeWitt, a professor of neurology and pharmacology and Parkinson’s researcher at the Wayne State School of Medicine in Detroit.
In 2015 — 16 years after the publication of the Gelb criteria, nine years before Special Master Hoffman’s landmark ruling — the International Parkinson and Movement Disorder Society (MDS) established criteria for Parkinson’s that incorporated both motor and non-motor symptoms. They rapidly became and have remained the global standard for diagnosing Parkinson’s in living patients around the world.
They are universally used around the world, that is – outside this NFL case.
In 2024, Special Master Hoffman wrote that his panel considered using the MDS criteria but rejected the idea. “[C]riteria such as those of the Movement Disorder Society,” his advisers wrote, “are designed to be used by movement disorder specialists rather than the neurologists who participate as [settlement-approved] physicians, who are not required to have this specialty expertise.”
By embracing that one sentence, Special Master Hoffman and the NFL Concussion Settlement dismissed the generally held view of Parkinson’s experts that the MDS criteria was created to be used by both general neurologists and movement disorder specialists as the years of work by experts across the globe in developing the MDS criteria created a state-of-the-art definition of Parkinson’s. As further proof of this, the MDS itself, whose experts researched, devised and tested the modernized criteria, disagrees. In a 2023 position paper, it said, “While the MDS-PD Criteria were designed for use in research, the MDS supports their use as a general guide to diagnosis of PD in clinical settings.”
“Someone in my field would say, of course we go with the international consensus as found in the recommendations of the MDS,” says LeWitt. “Because we know the method they went through. It’s been validated multiple times, it’s continuously being updated with commentary and editorial and peer review.”
“I will leave it to others to decide which criteria they find most compelling, and whether and how to incorporate more recently developed diagnostic tests,” says Gelb, who still teaches at the University of Michigan.
The special master and settlement managers have used Gelb’s 1999 criteria since the 2024 ruling and have worked hard to make them stick. “We never got the chance to ask about that,” says a doctor who joined the settlement’s group of Monetary Award Fund (MAF) physicians—the doctors approved by the NFL and lead attorneys in the case to diagnose players—at its inception. “We just got a notice telling us that now we’re going to do this, and now you fill that out. We didn’t have a discussion about it.”
The results were sudden and severe: Narrower criteria for Parkinson’s, narrower windows for athletes to be approved and paid. Players who were diagnosed with the disease before 2024 and whose cases were still pending soon found themselves in a difficult situation. If a doctor didn’t mention the Gelb criteria in an athlete’s initial evaluation, that would now torpedo his claim. But if that doctor tried to revise his report, he and the player could be accused of “back-filling.” As Hoffman put it in a July 2025 ruling rejecting one player’s Parkinson’s claim, “These new and amended documents represent ‘late-arriving reasoning,’ which ‘cannot substitute for the actual reasons’ Dr. [redacted] outlined at the time of his Diagnosis. Simply put, ‘no deference is due to clinician’s letters produced on Appeal.’”
Meanwhile, players getting new evaluations have often learned their physicians cannot submit qualifying diagnoses for Parkinson’s even when they’ve concluded an athlete needs help. “It is restrictive and absolutely does keep me from diagnosing some patients,” the MAF doctor says. “With some patients who have early or subtle symptoms, you can tell there’s a good chance that they either have early Parkinson’s or are high risk for it, but they don’t quite meet the Gelb criteria.”
Attorneys for players report the process for Parkinson’s claims is now clogged with challenges to qualifying diagnoses. “It’s taking longer and longer for the claims to be decided,” says Michael Leh, a partner at the Locks Law Firm, which is based in Philadelphia. “And there’s much more questioning of the diagnosing neurologists.”
Through January 16, 2024, 275 Parkinson’s claims were submitted to the settlement, and 235, or 85%, were approved, according to data in reports by BrownGreer. In the year following Hoffman’s ruling, the settlement received 60 new claims and made 45 new awards, for a 75% ratio. In the past year, that number has plunged to 44%. “Using that Gelb scale is not the fairest thing, or the most objective scientifically guided,” says one prominent neurological professional. “But the more rigorous diagnostic scheme is a cost-effective way of not paying out much money.” Significantly, in addition to the increased Parkinson’s denials, a high percentage of Parkinson’s claims have been put on hold and are in limbo, according to plaintiffs’ lawyers.
Plaintiffs’ lawyers and medical experts also view as an additional attempt to weaken Parkinsons claims, that the settlement’s claims administrator recently launched an “audit” of many law firms that are representing retired athletes, and has already drawn up a 91-page report. “So many more players have Parkinson’s disease than they ever anticipated,” says one plaintiffs’ attorney. “And the administrator and the NFL are taking the position that means they can’t be legitimate claims.”
Reece hopes to compel the league and its allies to consider definitions of Parkinson’s and “legitimate” that go beyond suppressing diagnoses—and to act soon. “I hope you hear me,” he says. “I’ve never met a player who’s mad at the game. But when I have conversations with them, they feel like the NFL is running a prevent defense. They’re just spreading out and making sure that you don’t gain many yards, and when the clock hits zero, the player dies. Pretty soon, all of the players that are in this case will be gone.”
Peter Keating is an investigative writer in New Jersey. His pioneering work at ESPN exposed how the NFL dealt with brain injuries.
