When I use visual micro to upload a hello world... it uploads to the Uno R4 minima fine... but then the USB disconnects... and it will not reconnect until I press the reset button twice,  but only after I use the Arduino IDE to upload new code.
When I use the Arduino IDE... it works fine.

Compiling 'Helloworld' for 'Arduino UNO R4 Minima(minima)'
Build Folder: "file:///C:/Users/james/AppData/Local/Temp/VMBuilds/Helloworld/minima/Release"
 
Program size: 38864 bytes (used 15% of a 262144 byte maximum) (1.17 secs)
Minimum Memory Usage: 3940 bytes (12% of a 32768 byte maximum)
 
Uploading 'Helloworld' to 'Arduino UNO R4 Minima(minima)' using 'COM4'
Uploader started for board Arduino UNO R4 Minima(minima)
Upload method will be: bootloader
Uploading via Bootloader 
duino5\dfu-util --device 0x2341:0x0069,:0x0369 -D .ino.bin" -a0 -Q
dfu-util 0.11-arduino4
Copyright 2005-2009 Weston Schmidt, Harald Welte and OpenMoko Inc.
Copyright 2010-2021 Tormod Volden and Stefan Schmidt
This program is Free Software and has ABSOLUTELY NO WARRANTY
Please report bugs to http://sourceforge.net/p/dfu-util/tickets/
Opening DFU capable USB device...
Device ID 2341:0069
Run-Time device DFU version 0101
Claiming USB DFU (Run-Time) Interface...
Setting Alternate Interface zero...
Determining device status...
DFU state(0) = appIDLE, status(0) = No error condition is present
Device really in Run-Time Mode, send DFU detach request...
Device will detach and reattach...
Opening DFU USB Device...
Claiming USB DFU Interface...
Setting Alternate Interface #0 ...
Determining device status...
DFU state(2) = dfuIDLE, status(0) = No error condition is present
DFU mode device DFU version 0101
Device returned transfer size 64
Copying data from PC to DFU device
Download      [                         ]   0%            0 bytes
Download      [=                        ]   4%         1600 bytes
Download      [==                       ]   8%         3136 bytes
Download      [===                      ]  12%         4736 bytes
Download      [====                     ]  16%         6272 bytes
Download      [=====                    ]  20%         7808 bytes
Download      [======                   ]  24%         9408 bytes
Download      [=======                  ]  28%        10944 bytes
Download      [========                 ]  32%        12480 bytes
Download      [=========                ]  36%        14080 bytes
Download      [==========               ]  40%        15616 bytes
Download      [===========              ]  44%        17152 bytes
Download      [============             ]  48%        18752 bytes
Download      [=============            ]  52%        20288 bytes
Download      [==============           ]  56%        21824 bytes
Download      [===============          ]  60%        23424 bytes
Download      [================         ]  64%        24960 bytes
Download      [=================        ]  68%        26496 bytes
Download      [==================       ]  72%        28096 bytes
Download      [===================      ]  76%        29632 bytes
Download      [====================     ]  80%        31168 bytes
Download      [=====================    ]  84%        32768 bytes
Download      [=====================    ]  87%        34048 bytes
Download      [======================   ]  88%        34304 bytes
Download      [=======================  ]  92%        35840 bytes
Download      [======================== ]  96%        37440 bytes
Download      [=========================] 100%        38872 bytes
Download done.
DFU state(7) = dfuMANIFEST, status(0) = No error condition is present
DFU state(2) = dfuIDLE, status(0) = No error condition is present
     The upload process has finished.
Done!

Thanks for the report and the solution to the issue (re-installing the board).

Can you confirm which version of Visual Micro you are currently running on your machine? (from Extensions > Manage Extensions > Installed > Click on Visual Micro and it will show the full version on the right hand side).