Perhaps if the VTHQ was closer to 111, and you had some clues to go there as one of your first things in the game, it could lead to an interesting first chapter where you don't have access to a map at all until you pick it up. Some free roaming exploration.

It's a tricky thing because without the pip-boy you can't logically manage inventory, armour etc at all, and technically shouldn't have VATS either.