@eorange I am using the same version of MMSSTV 1.13A and Audacity 2.4.2 and it does not appear you are doing anything wrong. What I do not do is change the RX mode to PD120. It is on "Auto" when the program is opened, but that should not change things. It might but the received audio is PD120 and MMSSTV automatically switches to that.
I have been using my D74A for these passes, but I have used my R30 in the past.
Audacity
1. Drag and drop wav file to Audacity. Edit length if needed, then Select > All
2. Choose the 11025 rate in the bottom left
3. File > Export as wav ( I give it a different name than the original wav file )
4. Rename whatever.wav to whatever.mmv
MMSSTV
1. File > Play sound from file
2. Select the whatever.mmv file and click Open
3. The audio will automatically start playing and you'll see the image in the RX window/tab
4. Export/Edit however you want after that.