Forgot to mention - The truck isn't throwing any codes/CEL
Ok, to answer the last question, the answer is yes, I still get the 1-2-3-4 shifts. Today, I was in it and it shifted fine the entire time, with about 3.5 total hours on the highway.Wouldn't expect this to be an issue in NM in August, but if the sump temp is below a certain level, the Torque Converter Clutch (TCC) will not engage, and the trans will not shift into 6th gear. So if this only happens on a cold start, that might explain it. Although once it warms up a bit, it should engage the TCC (and 6th gear) OK, without having to restart it.
Otherwise, you're correct that this usually indicates an OD clutch on the way out. When it avoids 5th and 6th, if you come to a stop and then take off again (without restarting it), does it shift directly from 1st to 4th, or do you still get 1-2-3-4?