From front lines to flightlines, Veterans get quality care at VAPHS clinic

The clinic, which opened in 2024, provides comprehensive evaluations and testing for Veterans with a history of complex exposures and respiratory symptoms. 

“The need is there,” said Tony Macedonia, a pulmonary physician who serves as the center’s clinical director.

Macedonia himself served as a Navy flight surgeon for five years, with one deployment to the Middle East alongside Marines.

“My exposures when I was deployed were at 20,000 feet,” said Macedonia, who has 13 combat missions in Afghanistan. “I saw sandstorms from the air; they were fairly impressive. I was on the flightline all the time. I know what it’s like when a jet engine kicks in and all that matter is kicking up into the air.”

Two of the four other pulmonologists in the center are also Veterans; Will Bain is a fellow Navy Veteran and Timothy Dempsey served in the Air Force. Clare Cene-Kush and Mohamed Seedahmed round out the team. Cene-Kush spent her pulmonary fellowship developing an education curriculum around deployment-related respiratory disease to help VA providers understand Veterans at risk, and Seedahmed has established research in the field, recently receiving a two-year research scholarship.

Every Friday, the team conducts three or four evaluations per clinic, involving thorough occupational lung histories. The doctors spend up to 90 minutes with each Veteran, after which the Veteran will have an additional pulmonary appointment. 

“When you dig deeper, you can discover abnormalities going on,” said Macedonia. “Our 90 minutes tease out details like how many deployments, was there a burn pit. The name of the game is subtle differences that other doctors might not identify.”

The team’s respiratory therapists run a pulmonary function test (PFT) lab to provide imaging and advanced lung function testing, including cardiopulmonary exercise testing (CPET).

“Then, as a team, we discuss every Veteran’s case at our case conference prior to definitively diagnosing the patient,” said Macedonia.

CPET measures a patient’s exercise limitations and helps identify why they feel they can’t reach their potential. Macedonia explained it can help guide the team with follow-on therapy.

“The respiratory therapists make all our advanced lung testing possible,” said Macedonia. “They have worked really hard. They all spent hours to learn CPET to offer that in our PFT lab. I really appreciate the team I have in place.”

They have seen about 100 Veterans and are working through a backlog of about 100 more. 

“Our first Veteran patient was also a respiratory therapist here, that was kind of unique.”

“Chemically Treated Poop Lake”

James Pritchard is the VAPHS respiratory therapist who is also Macedonia’s patient. His military service includes about 22 combined years in two branches. He served from 1979-1991, then from 2011-2014 in the Army, transferring into the Air Force with no break in service and retiring in October 2021.

He started out as a combat engineer in the reserves, deploying in the ‘80s to Honduras.

“We were putting in a road to get troops and supplies to Nicaragua, plus training Honduran troops,” said Pritchard. “The base was in the middle of the jungle six hours from civilization. We were pretty close to the Nicaraguan line, and the country was under martial law. We carried arms fully loaded in case we were attacked.”

After graduating from college in the early 1990s, Pritchard started his medical career and later began at VAPHS in March 2005 on medical-surgical units, where he still works.

In 2011, he re-entered the Army, attending training to become an information technology specialist and deploying to Kuwait for nine months. 

“Those sandstorms are no joke,” said Pritchard. “I got caught in one in Kuwait. It was a pelting.”

During deployment, he was transferred to Kandahar, Afghanistan, to support another unit for three months before returning to complete his tour in Kuwait.

“I was more concerned about the big lake of chemically treated poop we were breathing in every day,” said Pritchard. “Burn pits were once a week, but the other thing put soot everywhere. I woke up in my 8x10 foot metal Conex one morning choking. I opened the door and it was black outside, snowing soot. I was blowing it out of my nose.”

He returned from deployment and resumed working at VAPHS in 2013. He also became a patient when his post-deployment reintegration required him to register and see a provider.

“It wasn’t until 2014 maybe when I noticed my run times were getting bad and I was coughing and struggling to breathe,” said Pritchard. “I went to the provider, and they started me on an inhaler. Then over the next years it got worse. That’s how I got hooked into the exposures and burn pits clinic.”

Pritchard has a unique perspective being both a therapist and patient at VAPHS.

“Sometimes if I see Dr. Macedonia at a code, he takes the time to ask, ‘how are you doing?’ He is really taking care of me. I can’t say enough good stuff about him. I feel confident in his thoroughness, and the care he’s giving is great.”

Pittsburgh Marine Veteran Back to Nearly 100% Lung Capacity

Pittsburgh native and Marine Corps Veteran Joshua Seitz has seen a drastic improvement in his health, thanks to care through the respiratory clinic. He served as a small arms repair technician from 2004-2008, deploying to Iraq in 2005-2006.

Seitz has been receiving care at VAPHS for about a year and a half and began receiving care from the clinic about six months ago.

He ran a lot in the past and always struggled with hills, finding himself easily winded. 

“I ended up doing awful on the pulmonary function test,” said Seitz. “I was at half lung capacity. It was pretty bad.”

After his initial PFT and lung scan, he talked with a provider who prescribed multiple inhalers and recommended a follow-on discussion with Macedonia. Together, the team discovered Seitz likely had severe deployment-related asthma. He began using inhalers consistently for two to three months before a second pulmonary function test. This time, his lung function was almost 100%.

Seitz has found another benefit; he ended up losing 35 pounds through being able to go to the gym and run more.

“I wouldn’t have been able to do that if I hadn’t been managing the asthma through the treatment,” said Seitz. “I’m glad I decided to go. I feel better.” 

“We’ll be here with them.”

Being a Veteran allows Macedonia to understand his patients better.

“Something simple they say can trigger you because you know what their MOS involves,” he said, referencing Military Occupational Specialty, or a service member’s job title.

Macedonia explained the significance of following a Veteran’s health over time.

“Giving them time to tell their story is very important to us,” he said. “Some things are subtle, so we might only pick up on something over a period of years. I feel like when they hear how much time we’re investing in them, even if there’s no other thing we can do except follow them for years, there’s that reassurance we’ll be here with them.”

Seitz was not used to the personalized follow up.

“It's very rare to have a doctor call you to see how you’re doing,” said Seitz, “I was like, oh, wow, they do care.”

Seitz encourages Veterans to look into any health concerns.

“I held off on getting help with multiple issues from PTSD, anxiety and all that respiratory stuff for a long, long time,” he said, “But since I’ve gone to VA, they’ve been nothing but really good. From getting help with mental health and my lung issue, which was a rough time trying to figure that out, I’ve got no complaints. I wish I’d gone 15 years ago.”

If you are a Veteran with health concerns or questions about possible toxic exposures during your service, talk with your provider or contact one of the Deployment-Related Respiratory Disease Clinic pulmonary nurses at .