In Fallout 3, this perk may be less useful to those who have chosen the Grim Reaper's Sprint perk, as it fully restores Action Points when you kill an enemy in V.A.T.S. However, since some new enemies (such as super mutant overlords) in Broken Steel require multiple V.A.T.S. rounds to kill, players on harder difficulty levels, and players having few Action Points may wish to consider taking the script-edited version of Nerves of Steel.
The perk was retooled in Fallout: New Vegas to make it far more effective than the lackluster version in Fallout 3. According to the New Vegas GECK, the perk now increases the regeneration rate of Action Points by +20% rather than a flat rate bonus.
pcxbox360 It has been reported that the perk is non-functional in Fallout 3 on both the PC and Xbox 360 with the version 1.5 patch issued for Broken Steel, but this is inaccurate. While the perk does function, the increase in action point regeneration rate is extremely low (amounting to 1 additional AP per 10 seconds). [verified]
pc If you don't equip a weapon, this perk will not take effect (PC patch 1.20.352, but made irrelevant due to future patch). [verified]