The SIP signaling is identical in both cases - INVITE, auth, 180, 183, 200, ACK all look perfect. SDP negotiation is correct. But when the media proxy is 172.31.61.127, the RTP just doesn't make it through.
Telnyx uses different source IPs from their AWS VPCs (172.30.x.x and 172.31.x.x ranges), and it looks like the media proxy 172.31.61.127 can't handle all of them. The issue is intermittent because it depends on which Telnyx source IP gets assigned.
To answer your question: yes, I'm using symmetric RTP/rport, and I have "Accept any RTP packets" enabled on the Telnyx side. I've reconfigured everything from scratch following Vapi's docs. I'm pretty sure my Telnyx config is solid.