Update
OK here is the scoop-
I could just barely get a wrench on the nut from underneath the truck, there is a big ass radiator hose in the way on my '05, and I had very little control over my adjustments I was making from there. The box is VERY accessible if you remove the fender liner. The extra 15 minutes to take it off and put it back on was well worth it. The adjustment is right out in the open this way. Very easy- total 45 minutes this time, would take me 20 if I did it again.
Makes a big difference in steering slop, haven't hit any big bumps yet to check for steeering oscillations.
Just a note, this is an 05 so it has front coils, the older trucks with leaf springs may be easier to adjust from the bottom, I do not know
Dave said he could touch the adjuster from the bottom, I couldn't even get my hand close. I was able to just barely get on it with a flexible gearwrench.