Did you get those alum straps that keep bolt torque in check with each other? On my 5.9 there was a TSB for those exhaust bolts. The fix was(after getting back to OEM) a little alum strap that punches over exhaust bolt head and then to the next bolt head. Keeps those things from backing out. Problem is when one bolt gets loose bolt next to it has to double duty, then exhaust manifold sometimes break because of uneven cooling or heating and mismatched torque. Just went out to shed and found extra with some part numbers. Maybe your engine also these things. Didn't have any more problems after putting these things on. I did use anti-seize being bolts couldn't go anywhere after putting on straps. Here is all numbers on package and not sure which is part number or dealer number etc.
1-05086935aa
73831B US
09/14/05
l-23
Maybe your part supplier can show you a pic, and see if available for your engine size. I bet dealers don't like these things, sort of cut them out of some business. (I don't post pic's on line because I haven't noodled that one out yet)
Anyway, all I do now is take a quick look when changing oil to make sure alum straps are still on. No more problems since 05
Again this is on 5.9, but a common problem with Cummins and I bet that fix was across the board.
OK messed around and found TSB. I know this is not your engine and maybe not year but those little straps kept mine in check. And the reference about towing or pulling a trailer just think translate that to "heavy use"
http://dodgeram.info/tsb/2001/09-002-01.htm