REVISED VERSION: On further reflection, I think the answer to your question is always "yes" (if $\mathfrak{g}$ is simple, to avoid complications of the type Dave indicates). At first I accepted too uncriticallywas confused by the example discussed in the question, where therebut I think the main issue is an unsupported statement which strikes me now as incorrect: "These two representations are actually isomorphic." This seems to behow the originautomorphism group interacts with Dynkin diagrams of the apparent contradictions which led to the questionnilpotent orbits.
In the classical Dynkin-Kostant treatment of nilpotent orbits in a simple Lie algebra $\mathfrak{g}$, the basic strategy is to embed a (nonzero) nilpotent element in a copy of $\mathfrak{sl}_2(\mathbb{C})$. Such an embedding isn't unique, but there is a resulting bijection between conjugacy classes of nilpotents (under the adjoint group of $\mathfrak{g}$) and conjugacy classes of such subalgebras. In turn, the adjoint action of the subalgebra leads to a decorated Dynkin diagram (with vertices labelled $0, 1, 2$) which determines uniquely the given nilpotent orbit. (Some references to textbooks by Carter and Collingwood-McGovern which include Dynkin diagrams are given in my old notes here.)
In your type $D$ example, there are typically pairs of orbits interchanged by an outer automorphism of $\mathfrak{g}$ that comes from a graph automorphism. While these These orbits do have many common properties, and corresponding copies of $\mathfrak{sl}_2(\mathbb{C})$ can'tdo act equivalently on $\mathfrak{g}$ sinceeven though they lead to distinct Dynkin diagrams. The key fact is that these Dynkin diagrams just involve a permutation of labels induced by the outer automorphism. Only in such limited cases can two subalgebras of type $\mathfrak{sl}_2(\mathbb{C})$ act equivalently in the adjoint representation of $\mathfrak{g}$: this is clear from the determination of Dynkin diagrams for each $\mathfrak{g}$.
[Concerning terminology, it's fairly conventional to call two representations equivalent but the associated modules isomorphic. The choice of either representation or module language is usually optional, at least in finite dimensional cases.]