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Why is the CH-53E's tail rotor tilted?
Short answer
The CH-53E's tail rotor was tilted 20° from vertical to provide some lift in hover while counteracting the main rotor's torque. In the same redesign, the low, symmetrical horizontal stabilizer gave way to a larger vertical tail.

From the CH-53D to the S-80
Before the requirement was issued, Sikorsky was already working on an improvement to the CH-53D under the internal designation "S-80". In the early 1970s, prototype trials studied adding a third engine and a larger rotor system with a seventh blade. As the Sikorsky S-80, the aircraft was developed from the CH-53 Sea Stallion mainly by adding that third engine, the seventh blade to the main rotor, and tilting the tail rotor 20°. The starting CH-53 was powered by a pair of General Electric T64-6 turboshafts of up to 2,850 shp (2,130 kW) each.
A tail rotor that also provides lift
The tail configuration was modified. The low, symmetrical horizontal stabilizer was replaced by a larger vertical tail, and the tail rotor was tilted from vertical to provide some lift in hover, in addition to counteracting the main rotor's torque.
The high horizontal surface
In that redesign, the tail incorporated a horizontal surface mounted high, facing the rotor, with an inner section perpendicular to the tail rotor that, from the strut joint onward, is canted 20° relative to the horizontal. That arrangement helps with pitch at high speed.
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