For those like me that skipped over the simple stuff and got frustrated, it appears Fallout NV doesn't like Spyware Doctor. My punishment was an evening of frustration and thinking about it for a day at work. I came home, started disabling the few programs I have running in the tray. After shutting down Spyware Doctor it loaded up and is running like a charm!

This in on Windows 7 64-Bit, nVidia GTX 460.