Fog, dust and smoke particles are hitting performance hard. I've seen this happen before in skyrim but it was fixed, now it's back.
There seems to be too much sampling coverage going on in the alpha of these particles. Some of them are controlled by the 'iMaxDesired=' function in Fallout4Prefs.ini and turning it off has some effect on dust but most of the interior fog is hand placed as a static object like in skyrim and can only be removed by the fallout 4 creation kit.
These pictures illustrate the fps difference, the text in my osd is blurry maybe because of gsync? idk.
Inside with lots of fog @36fps:
http://oi67.tinypic.com/2zdoxon.jpg
Outside with lots going on @60fps:
http://oi64.tinypic.com/sol1lt.jpg
I've tested occulsion too and it works pretty well so it's not that at fault here. Any input from anyone familiar with this stuff would be great!