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you need to make a custom ini file
I would recommend doing this.
I had many problems in the past years with the game not saving changes or me needing to make the Fallout76Prefs file read only in order for my changes to stick, but then game menu changes cannot save due to the read only status.
Also had odd things like some settings would not work at all in the Prefs file but would work in the custom ini. Since going to a custom ini I have had no problems like this anymore.
It should work that way but...........
For me back when i started playing turning it off in Nvidia control panel would not disable Vsync in the game. I still had to edit the ini to turn Vsync off and get better FPS. Without editing the ini I was stuck at 48FPS which is exactly 1/3rd of my 144hz monitor refresh rate. Common problem with the game and high refresh monitors.
Helped out many other players over the years with the same issue.