Scott Weakley, 47, of Denver already had three deployments under his belt when he was sent on back-to-back missions in Pakistan, Afghanistan and Iraq that started in 2004.
Weakley, a marathon runner, was in peak shape, and said he was physically charged for the work ahead. But within five years, Weakley transformed from the lead runner in his battalion to a patient who may now need a lung transplant.
Weakley was diagnosed with constrictive bronchiolitis, a relatively rare irreversible lung condition marked by inflammation and scarring in the airways.
While serving overseas, Weakley inhaled thick plumes of smoke from open pits that regularly burned material and human waste, debris and chemicals. Weakley said burn pits were a constant presence near the U.S. Embassy in Pakistan, and some bases and outposts in Iraq and Afghanistan.
"I knew at the time that smelling it could not be good for me," said Weakley. "I just remember trying to cover with my BDU [battle dress uniform] shirt."
While serving in Iraq, Weakley was also exposed to fierce dust storms, which may also have contributed to his condition, his doctors told him.
Like Weakley, a growing number of soldiers who have served early on in the wars of Iraq and Afghanistan have now been diagnosed with deployment-related lung disease that comes from inhaling toxic waste from sources like dust storms, combat smoke and burn pits.
While the U.S. Department of Defense reports that it has shut down all burn pits in Iraq -– replacing some with closed incinerators -- and plans to do the same in Afghanistan by the end of the year, new evidence suggests the health effects may be irreparable for soldiers who were already exposed.
A new report by researchers at Vanderbilt University found that nearly half of 80 soldiers in Fort Campbell, Ky., who could not pass a standard 2-mile run because of breathing problems, were diagnosed with constrictive bronchiolitis. More than 80 percent of those with constrictive bronchiolitis had been exposed to dust storms, and more than 60 percent had been exposed to burn pits, according to the report, which was published Wednesday in the New England Journal of Medicine.
"I don't' think that we can say that our data says these exposures are the cause, at least not yet," said Dr. Robert Miller, author of the study. "But I think it is very concerning."
Standard tests that are used to detect respiratory diseases, such as a pulmonary function test or CT scan, could not pick up the soldiers' condition. Only a lung biopsy could detect constrictive bronchiolitis in the soldiers, Miller said.
"A large number of soldiers who have these respiratory disorders are being missed," said Miller, who suggested that more soldiers may have a form of respiratory condition and not know it.
While a pulmonary function test picked up Weakley's condition, Miller said that many doctors won't test further if standard tests fail to find anything.
"It's unusual for someone to take people normal on the tests and still give them a biopsy, but it's the only way these guys would've gotten the compensation that they needed," said Miller, who recently served on an American Thoracic Society speaker's panel with Weakley.
But, he said, serious respiratory cases might be easier to detect if soldiers had a record of their breathing capacity beforehand.
"Everybody that is deployed should get a pulmonary function test before deploying, said Miller. "If we have baseline breathing test on everybody we were seeing, then that would limit the amount of biopsies."
Weakley said his wife was the first to notice that something was wrong. Weakley recalled calling her within a week of his first exposure to the burn pits in Pakistan.
"She wondered why I was having a tough time talking," said Weakley, who was not one of the cases reported by the Vanderbilt researchers. "She recognized something was wrong over the phone."
Although Weakley felt short of breath, he chalked it up to exhaustion from long hours and little sleep.
"I was trying to decipher the reality and the psychological," said Weakley.
At the time, Weakly said, doctors told him he may have asthma, a common diagnosis among many soldiers deployed to Iraq and Afghanistan.
"When I got home [in July 2005], my wife from the get-go said I don't care who you see, something is wrong," he said. "It didn't hit me until I got home."
Post-deployment lung diseases like Weakley's sometimes mirror less serious respiratory infections, because it's unclear what's causing the condition, said Miller.
"There's pigment in the lung area, but we don't know exactly what that chemical or exposure is yet," he said.
Miller said he is now working with Weakley's pulmonologist at National Jewish Health in Denver, Dr. Cecile Rose, who will examine the biopsies to find the exact chemical that is causing the condition among soldiers.
Weakley, who could once run two miles in less than 13 minutes, found that he had to stop and catch his breath. In 2008, after five deployments in more than 20 years of service, Weakley received a medical discharge from the Army.
Now Weakley said he struggles to keep up with his 8-year-old and 11-year-old children.
"Before I left, I could do anything and everything," said Weakley. "I never thought I would have to brush the idea of a lung transplant."