Great list. Items 1-5 are well described and sadly accurate.
Overall I'd say I agree with you "about 85%" regarding McVay's excess of caution.
A few thoughts:
1. I think that "occasionally" McVay was aggressive (even with a lead) in 2025. My source? "Trust me bro."

Seriously though... I can't remember exactly when or which games, but I remember thinking a few times last year, "McVay is going for it here and being more aggressive than normal." Rams went for it 30 times on 4th down in 2025 (11th most in the league) and converted 20 times for a 67% success rate.
2. Just to underline it, McVay explicitly said he was "sick" about his decision on 3rd down at the end of the Bills game. So at least he acknowledged right away that he was overly conservative.
3. Let's face it and at least acknowledge the other side of the coin-- yes, McVay is conservative, but he wins a lot of games that way. We as fans might forget or overlook all the times that McVay wins games with his analytics driven conservative approach. Unnecessarily close wins? Maybe. But a lot of wins nonetheless.
4. Just to contradict myself... i think McVay shows a nice mix of aggression and conservatism with his play calling in general. Rams consistently have an elite offense every damn year. So yeah, SITUATIONALLY he has too many conservative tendencies. But overall as an OC he's got a nice mix.
5. Agreed that McVay isn't always great at "reading the room" as you say and letting his instincts flow. On the other hand, McVay is an absolute meticulous freak. His photographic memory is just otherworldly. So maybe it's just the price we pay for his strengths. He can get overly cerebral and not ride that crest of feeling enough.
6. To add one to your list: on Monday night McVay wasn't aggressive enough with his timeouts at the end of the first half. Bills were playing footsie and being conservative and bleeding clock. I was screaming at the TV for McVay to take a risk and call a timeout. Instead, after we make the stop we only had 20 measly seconds for a counterstrike. BAD clock management that was excessively conservative.
Bottom line... I mostly agree with you in that I wish sometimes McVay were more aggressive. Just throwing out a few observations to provide some nuance.