He has, according to Al, been his enemy "for years". It's unclear what forces the not-so-good doctor commands, but it has been speculated that he may be in charge of the barrels that inhabit the wasteland, (explaining why Al's companions always make sure to knock them over) commander of the radios, or both.
It is confirmed that he is real, much to Al's surprise, in New Vegas Montages: Farewell New Vegas. He is aligned with the Business Radroaches and the Radios, working for them as an executioner. Doctor GarbageCan is on the council and ultimately decides that Al should be sentenced to death for his crimes against the Radroaches and Radios.
- He has made an appearance on Al's channel art.