Rage and Tears: Fallout 3 on Very Hard
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While TES: Oblivion seemed to punish the player for utilizing a stealth character, using stealth in Fallout 3 on Very Hard is outright critical. You'll likely use the Chinese Stealth Field armor acquired from Anchorage for quite some time due to the DR and the stealth field stat. Despite 'only' being +5, it's a massive improvement and in conjunction with the sneaking bonus, it can make getting in position for sniping shots much more feasible.
Using the silenced 10mm pistol to crit at least one or two enemies out of a group before you're noticed is also a critical strategy until you get the commando and sniper perks which will enable you to start one-shotting your enemies.
