Well, one thing for certain is, you're not supposed to use the Ryzen Balanced power plan with Ryzen+ CPUs. That power plan is only for the first gen Ryzen CPUs and will cause worse performance and power usage with the newer generation. You should be running your Ryzen+ CPU using one of the standard Windows power plans.
Run everything at stock for a while and see if the issue goes away. If it does, it's related to your settings. Change them one at a time to see which one is the problem.
1.38 actually sounds a bit low to me for an all-core overclock. Ryzen+ CPUs usually end up running in the 1.4 - 1.5 V range when boosting all cores to high frequencies.
Off the top of my head:
You don't mention what graphics card you're running or whether you have high frame rates going on in your game, but I suspect Diablo 3 isn't too much of an issue for your GPU unless it's mid to low tier. If it's a high end card, it's very likely the CPU is working more because of a high frame rate that you may not even be seeing, causing power usage of the CPU to spike. If your voltage is too low for the CPU under certain conditions, I could imagine you might bump into the black screen Ryzen issue, or perhaps a power down. Running without your overclock on the CPU might sort it, as the CPU will probably perform the same boosting using high voltages than you're allowing.
You don't mention how you are checking your 12 V rail for stability. This really has to be done with something like an oscilloscope for any sort of accuracy, so good luck with that. Software isn't going to cut it and a multimeter or volt meter is going to be way too slow to show you what's actually happening at the sub-second level.