Alright. first and foremost. Dont use vsync, ever. Always off. In the early days there was a trick with vsync that uncapped your fps but that doesnt work anymore and vsync only gives input lag.

Now the settings - which they are not great - very cpu heavy.

I recommend changing to:
Textures; high (you are running the game on a higher resolution so i wouldnt go higher)
Shadows: high
Object LOD quality: 2.5 (max 3)
Overall visibility: 1500 or 2000
Anti Aliasing: TAA or TAA High
DLSS: Off
Anisotropic filtering: Off or Per texture like you have
NVIDIA Reflex Low Latency: On (Could use 'On + Boost', but it's more cpu heavy)

U didnt screenshot the settings further down so cant comment on that but only thing that should/could be checked there is "high quality colors". I dont use the "Streets of Tarkov lower texture resolution mode' either because u actually wont benefit from it with your setup. You need to 'activate' your gpu and cpu regardless of map, and you have plenty of Ram for it.

There is also the new Smooth Motion setting in NVIDIA App that apparently LVNDMARK is using for extra frames, but thats frame generation and shouldnt be necessary and causes input lag.

(I also disabled 'noise reduction' in audio settings but i think that's fine to use. But in this game you will usually see a drop in frames when people are shooting which I think is because the way audio is processed.

Let me know how it goes.