The reason for the problem is easy.
When you use HDMI or optical your receiver does the decoding of some audio formats. FNV messes this up by creating more than one audio stream and on top of that in different formats and just spams them to the audio renderer at the same time.
At that point your receiver gets a signal that he recognizes and decodes and a signal that is already decoded PCM data at the same time, that doesn't work and he only plays the signal he decodes. When the music stops my receiver switches modes and actually plays sounds and voices till the music starts again.
On top of that the streams are completely different channel formats, the music is stereo, the effects are multichannel, that is something that ONLY works on a pure PC setup, as soon as you send your audio over optical, digital or HDMI to a receiver this doesn't work.
What that means is, my receiver decodes the music signal and skips the effects and voices cause they are in a different format.
What do decent games with competent programmers do ? They go and mix their audio streams together into a common format before sending it to the audio renderer in windows. FNV uses an incredible lazy and poorly thought out method of getting their audio to the renderer.
Btw, the slowdowns and most other audio problems you find here in the forums are mostly related to this fact, audio slowdowns, skipping audio, missing audio, audio crashes, it's all due to the fact that they just messed up their audio pipeline and that just makes for all round fun.
The people who "fixed" it, actually just bugged out their audio renderer to the point that their receiver/TV or whatever audio playback device doesn't do any decoding anymore, you installed codec over codec till you now have all audio pre-decoded on your pc....and believe me, your receiver, even a cheap one, does a better job than any software decoder. So you basically just degraded your audio setup just to compensate for lazy programming.
Ironically, on XBOX and PS3 you won't have the problem because they HAD to program a correct audio pipeline since those consoles are connected to receivers in most cases and therefore they had to obey standards, they went out of their way to mess up the PC version.
I doubt this will ever get fixed so I can't play this game (if there were at least a turn off music option (no, the volume levels don't work because the receiver decodes the signals and therefore regulates volume and turning music volume to nothing actually doesn't turn it off, it still plays, just muted)).
On that regard, thanks Bethesda/Steam for perma binding the serial to my account so I can't even sell the game that I can't play due to your incompetence....well played, but I learned my lesson.