Well, all of your listed choices are significant issues.
But since you asked for ‘biggest’ I have to choose McVay.
He’s responsible for and has control of all of the listed issues. McVay’s O has regressed from unstoppable in early ‘18 to feeble in ‘20.
It’s been a gradual dialing back kinda process for 24 months or so. We’re now reduced to bottom feeder scoring O status when 2 years ago we were highest scoring and most feared O in the league.
Look at this roster of skill players prior to the Akers/Hendy injuries:
Goff
Akers/Hendy
Woods
Kupp
Reynolds/Jefferson
Higbee
Everett
Nary a Pro Bowler among them, but hardly a bunch of bottom feeders, either. Read my lips. This O is underachieving and has been increasingly so for quite some time.
Rams have lost at LEAST 4 games to teams it should have handled rather easily this year.
Dolphins
49ers (twice)
Jets
So, I place the most blame on McVay. I’ve been a big McVay fan from the jump but this ain’t 2018 anymore and it is what it is. Hopefully, McVay pulls himself together this offseason and rights this ship on O.