Thanks!
So in this particular case when this issue cropped up, I had 2 VPNs drop between 3 pfSense machines.
FW-A: Single pfSense box
FW-B: HA pfSense boxes
FW-C: HA pfSense boxes
There are 2 IPsec VPNs: 1 between FW-A <-> FW-B and 1 between FW-A <-> FW-C.
I did find that the "Disable all auto-added VPN rules" was enabled on FW-A and FW-C which is now disabled, but the setting was already disabled on FW-B.
Looking at /tmp/rules.debug under "VPN Rules" I see rules on both FW-A and FW-C, but none under FW-B. Any idea why? I've double and triple checked the "Disable all auto-added VPN rules" setting and did note that when enabled, a comment under VPN rules is noted as disabled so I know the setting is being noted.