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And, uh, don't alt-tab out if you can help it.
As always, Your Mileage May Vary, but this is what worked for me.
First, remove all audio devices from your connected Bluetooth devices except for the headset you are using.
Second - go to Settings - Microphone Privacy Settings - scroll all the way down, then check "Allow desktop apps to access your microphone" to the OFF position.
P.S. it helped to fix not only the Fallout 76 sound issue, but also Titanfall 2!
Anyway, hope it helps. Cheers!