Chronic obstructive pulmonary disease (COPD) exacerbations are a leading cause of morbidity and mortality, particularly in patients with systemic comorbidities such as chronic kidney disease (CKD) and coronary artery disease (CAD). A 68-year-old male presented with acute dyspnea, peripheral edema, and hyperkalemia. Imaging revealed pulmonary congestion, and lab findings confirmed CKD Stage 5 and troponin elevation. This case highlights the complexity of managing a severe COPD exacerbation in a veteran with CKD Stage 5 and CAD, compounded by a history of Agent Orange exposure.