The NM_003494.4: c.757C>T variant in DYSF, which is also known as NM_001130987.2: c.853C>T p.(Arg285Trp), is a missense variant predicted to cause substitution of arginine by tryptophan at amino acid 253, p.(Arg253Trp). This variant has been reported in at least 10 individuals with symptoms consistent with LGMD (PMID: 16010686, 18853459, 24803842, 25868377, 26404900, 27666772, 30564623, 30919934, 36983702; LOVD DYSF_000205), including in a homozygous state without reported familial consanguinity in one patient (0.5 pts; PMID: 30919934) and confirmed in trans with a likely pathogenic or pathogenic variant in two patients (NM_003494.4: c.5979dup p.(Glu1994ArgfsTer3), 1.0 pt, LOVD Individual #00215315; NM_003494.4: c.2894G>A p.(Trp965Ter), 1.0 pt, PMID: 36983702) (PM3_Strong). At least one patient with this variant and a second presumed diagnostic DYSF variant displayed progressive proximal muscle weakness and significantly reduced or absent dysferlin protein expression in skeletal muscle or blood monocytes, which is highly specific for DYSF-associated LGMD (PP4_Strong; PMID: 36983702, 27666772, 25868377). The highest minor allele frequency for this variant in gnomAD v4.1.0 is 0.0001890 in the European (non-Finnish) population (223/1180018 alleles), which is higher than the LGMD VCEP threshold for PM2_Supporting (0.0001) (criterion not met). The computational predictor REVEL gives a score of 0.614, which is below the VCEP's threshold of 0.7 for PP3 (criterion not met). However, immunofluorescence and 2-A assays of dysferlin membrane localization in HEK293T cells showed the Arg253Trp protein did not reach the cell membrane, indicating an impact on protein function (PMID: 35028538) (PS3_Moderate). 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 1.0.0; 07/08/2025): PM3_Strong, PP4_Strong, PS3_Moderate.