Okay, I got the new patch via Steam and ever since there is a large black border on the right hand side of the screen and the entire game has shifted to the right. Almost a full 2 inches of the left side of the screen are no longer visible and the right side is completely black. The whole game screen has shifted 2 inches to the left. How do I fix this?

I don't know if this helps but whenever I launch New Vegas the monitor has a small blue screen pop up in the middle saying: Auto-Detect in progress... It never did this prior to the new patch, so I would be grateful if you fixed whatever the hell you broke.

a few things to try

- set the resolution lower in the launcher menu. run the game. quit out. put the resolution back to what it was before via the launcher and run the game again....

still not working?

- run the game using the existing resolution and press the auto-adjust/auto-sync, or whatever its termed on your monitor, button and itll shift the screen back.

Sounds to me like an issue with Windows Sidebar. Its not an issue I have since I don't bother using the Sidebar anymore.
Ever since I saw the Sidebar flash through a game whenever one of the Sidebar apps was updated I stopped using it.
And I only ever saw that happen with Oblivion and Fallout 3 ie games using the Gamebryo engine.

Try uninstalling and reinstalling graphics drivers and monitor drivers - you may want to reconsider using the Sidebar too
or turning it off when playing this game.

I'd try reverting to the default .ini and removing the ones in my games folder. In fallout 3, I remember how load screens would have a slight bar with the 3D stuff visible underneath that went away after the game loaded and how sometimes the pip boy screen would get smaller and shift. Not sure if that's the same thing though