That is the default setting in pfSense.
There is no SIP ALG unless you install the siproxd package, which you shouldn't.
All ports are open outbound for any devices on the LAN.
So unless you have added firewall rules to block traffic it should be allowed. However I would check the firewall log when it fails. I would also check Diag > States to see what states are open to/from the ATA191 IP and what changes after you reboot and it starts working again.
The only thing that pfSense does differently to many (most?) SOHO devices is to set a random source port on outbound connections. Some services, including VoIP, object to this (VoIP and NAT are mortal enemies! ) requiring a static source port rule to be set:
https://docs.netgate.com/pfsense/en/latest/recipes/nat-voip-phones.html#disable-source-port-rewriting
Steve