I like the combat system, though not perfect, it can give you a good time. EVEN IN 3RD PERSON. I am playing a lot in 3rd person and if the target is not below you (damn roaches), you can hit easily. Actually i hit more in 3rd than in 1st... (blame my bad aim, ok).
As others already said, Better Locational Damage is a great mod to adjust the difficult. I even downloaded other mods, opened the plugins with fo4edit and used some of the changes in my own esp, like heal with water and etc.
I can not even say exactly which mods i am using because i made lots of changes in the esps haha
But let's see, Better Locational Damage, Better Perks, Realistic Enjoyable Survival Tweaks (only the stealth plugin), More Intimidating Courser (i removed power armor manually), Deadlier Deathclaws, Weapon Muzzle smoke and smoke trails with some changes from Weapons of Fate, Critical Hits outside of VATS, Crippled Limbs Fix (this esp is a treasure chest, i integrated LOTS of other small fixes here haha), Stimpacks don't fully heal limbs, Permanent Pacification, Intoxicants of the Commonwealth, difficult xp scalling (to receive much LESS XP), and as said, maybe others.