; and (ii) such specialty care or services are so furnished either— (I) in accordance with this section with respect to fees and payments for care and services furnished under subsection (a); or (II) at no cost to the United States. (D) In making the determination under subparagraph (B), the Secretary shall give priority to medical facilities and health care providers of the Department but shall take into account— (i) whether the veteran faces an unusual or excessive burden in accessing such specialty hospital care, medical services, or extended care services at a medical facility of the Department, including with respect to— (I) geographical challenges; (II) environmental factors, such as roads that are not accessible to the general public, traffic, or hazardous weather; (III) a medical condition of the veteran; or (IV) such other factors as determined by the Secretary