Yeah i think thats my best bet, i just altered some settings, seems that Steam kept setting my graphics to somewhere between High and Ultra. Although im getting a fair amount of stuttering and lag at either graphics setting, is there a mod to reduce some of that stuttering especially in some of the distant vistas. I also can see that my biggest issue is from this weird contrast between the blue sky and the orange environment as well as in the lighting of some of the interiors. Also the high resolution of the things added by mods really make some of the things in the game that are unaltered look rather ugly. I do have to say that the tutorial house at the beginning looks great so its not all bad, ill try out Fellout and hope i can get my game to look how i want it too, is there a patch i need so that it works with my any of my current graphic mods?
I would recommend trying the URWLified version of Nevada Skies for better world lighting. Make sure to also download the URWL cloud pack and install after the data module.
For interiors you should try http://newvegasnexus.com/downloads/file.php?id=35794. It makes indoor settings look more natural but tends to be darker.
http://newvegasnexus.com/downloads/file.php?id=41101 and http://newvegasnexus.com/downloads/file.php?id=39755 both have a bunch of great textures to improve the overall look of the game. From my experimentation Textures Over Time's Rocks and Canyons do not look good with Detailed Normals but the awesome rocks more than make up for the loss.
I use New Vegas Stutter Remover which reduces wasteland stutters for me. The default settings cap you to 30 FPS. This is however easily changed through configuring the ini file although not necessarily wise as the FPS cap gives extra power to ease out the stutters.