True. This is done to handle the very rare cases where something crashes when you start the IDE, so we get some information without having to ask people to run regedit and start setting registry flags.
The file should be quite small, and this has basically no meaningful on performance, so I would recommend just ignoring this file
Just delete the "Startup.bak" file, this is the backup. If you are not seeing any current problems then you can just delete both of them.
I am not sure why it should be so heavily fragmented though. The fact it is in the same directory tree as VA's symbol databases might be a factor, if the file system is placing these files close together.
That seems a lot of fragments for a file that small. Is your drive heavily fragmented, or low on free space?