@huczekdesign - the failure of this patch can be traced to this point on the model-

if you zoom in a bit you will see there are 2 vertices nearly on top of each other here-

the edge segment between them is really small.

In certain cases, fusion often has trouble with really small things like this. it's been explained before on the forum as to why but I don't remember the specifics. but basicly - math. In the same way it has problems with really small angles and near tangency conditions.
this occurred when the surface was offset. so tracing this back to sketch 7, we see these 2 lines aren't parallel, but rather have a very small angle between them-

so I put a horizontal constraint on it-

which broke the fillet at 5mm, but setting it to 4.9mm allowed the fillet to work. I didn't investigate this.
so with the sketch fixed and the fillet fixed, the patch applied with out any error. see attach model.
moral of the story-properly constrain your sketches.
I would get away from relying on using the fixed constraint.
I wouldn't convert a mesh to a brep, but rather use it as a visual reference only and draw everything from scratch.