The only real, meaningful consequence is that, unlike places with contractual PTO, you don't end up accumulating the PTO you don't take, so you don't get a payout when you leave the company.
I worked at a startup and by conventional numbers I would have had easily accrued ~2 months of salary with unused vacations, but I left and didn’t see any of it. And clearly taking vacation was never “the right time” over the years because there was always some fire to extinguish.
After that I only worked in companies with fixed vacation days, some of which also paid the unused days at the end of the year rather than rollover or losing them, which was nice.
Take as much as you need but at least 15 days a year.