The NM_003494.4: c.1254del p.(Phe419LeufsTer41) variant in DYSF, which is also known as NM_001130987.2: c.1350del p.(Phe451LeufsTer41), is a frameshift variant expected to introduce a premature stop codon in exon 15/55, leading to nonsense mediated decay in a gene in which loss of function is a known mechanism of disease (PVS1). In the literature, this variant has also been described as p.(Pro418ProfsTer123). This variant has been reported in at least three patients with features consistent with LGMD (PMID: 27647186, 26404900, 26404900), including in a homozygous state without reported familial consanguinity (0.5 pts, PMID: 17994539; PM3_Supporting). This homozygous individual had both progressive limb girdle muscle weakness and absent dysferlin expression in skeletal muscle via both immunohistochemistry and Western blot (PMID: 17994539; PP4_Strong). The highest population allele frequency for this variant is 8.475e-7 in gnomAD v4.1.0 (1/1180008 European (non-Finnish) alleles), which is less than the threshold of 0.0001 for PM2_Supporting, meeting this criterion (PM2_Supporting). In summary, this variant meets the criteria to be classified as Pathogenic for autosomal recessive limb girdle muscular dystrophy based on the ACMG/AMP criteria applied, as specified by the ClinGen LGMD VCEP (LGMD VCEP specifications version 2.0.0; 09/17/2025): PVS1, PM3_Supporting, PP4_Strong, PM2_Supporting.