Setting to very hard or survival?

Survival is basically Very Hard but with slow regen for health when using items like Stimpacks. It just makes things more of a grind, I dont think it actually makes enemies more difficult.

Yeah, Survival is just Very Hard with slower health regen from aid items. I think people overstate how grindy it is, though... you take double damage and deal half damage, which isn't so bad - think of how the weapon damage perks essentially double your damage at five ranks. Enemies seem to die at a decent enough pace for me to be okay with it, and it seems like ammo scarcity is perfectly balanced for it to actually be a concern at Survival difficulty. Although I do understand that some people like faster-paced, faster-killing combat.

This^

yeah, survival is fine

it will stay tough for the majority of the game... but I never had any serious bulletsponges, apart from the legendary enemies at the start

it just obviously requires knowledge about the crafting system and that you pick the damage perks as soon as you can