The NM_003494.4: c.1178_1180+4dup variant in DYSF, which is also known as NM_001130987.2: c.1274_1276+4dup, is a duplication of 7 nucleotides spanning the boundary between exon 12 and intron 12, causing exon 12 to be extended by 7 bp and introducing a frameshift and premature truncation, p.(Met394SerfsTer20), with nonsense mediated decay expected (PVS1). While the GT at the original +1,2 position is maintained in the presence of the duplication, the splice donor at the original exon-intron boundary is not expected to be used because it is ablated by the duplication-induced replacement of GT with AG at the original +5,6 position. This variant has been observed in a heterozygous state in two patients with a clinical suspicion of LGMD or other muscular dystrophy, including one with a complete absence of dysferlin immunostaining in skeletal muscle. However, no second allele was identified in either case (PMID: 18832576, 30564623; LOVD Individual 00222254) (PM3_Supporting and PP4 not met). The upper threshold of the 95% CI of the Grpmax variant allele frequency is 0.0001051 in gnomAD v4.1.0 (3/73748 African/African American chromosomes), which is greater than the ClinGen LGMD VCEP threshold for PM2_Supporting (<0.0001) (PM2_Supporting not met). In summary, this variant meets criteria to be classified as Likely pathogenic for autosomal recessive limb girdle muscular dystrophy based on the ACMG/AMP criteria applied, as specified by the ClinGen LGMD VCEP (specifications version 2.0.0; 03/23/2026): PVS1.