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Have you tried using big picture mode? I don't use a controller, I know that usually people want to be playing with k/m and accidentally leave their controller plugged in and that throws the game off.
Have you been able to play the game UNMODDED with that same setup and using your controller? It's possible that your mod organizer is overwriting or not looking for the right ini file.
MO2 might be set to using its own ini files not the vanilla game's. If so the launcher needs to be configured for and run through MO2.
in steam if you go to settings, controller, general controller settings... does it show the controller you want to use? under "detected controller" with just steam running?
now if you start MO2 (or whatever mod installer you use) but not fallout 4, does it show the controller in steam?
i did a quick search and there is several topics on different sites over the years of problems with use controller with MO2 in skyrim and fallout 4...
only thing i can see as a possible solution is people saying MO / MO2 use their own INI files for the games, so you have to check them and enable gamepad in there... i haven't used mo2 in years so i don't remember how it works anymore. (tho i do remember having some problems with skyrim ini when i did use it)
[General]
bGamepadEnable=0
it says =0 for false, yet I was able to enable my PS5 controller without issue within the game's settings menu under gameplay.
you could try changing that line to read
bGamepadEnable=1 and then save, but I didn't have to do that on my install running MO2 with F4SE enabled.