The NM_213599.3 c.242A>G variant in ANO5 is a missense variant predicted to cause substitution of aspartic acid with glycine at codon 81, p.(Asp81Gly). This variant has been detected in at least 13 unrelated individuals with features consistent with LGMD or anoctaminopathy (PMID: 30564623, 29970176, 23047743, 22980763, 31395899, 22402862; ClinVar SCV001574736.5, SCV000582412.4 internal data communication), including in unconfirmed phase with a pathogenic variant in six unrelated cases (c.989dup p.(Leu330PhefsTer6) x2, 1.0 pt, PMID: 30564623, LOVD Individual #00220727, ClinVar SCV001574736.5 internal data communication; c.191dup p.(Asn64LysfsTer15) x2, 1.0 pt, PMID: 30564623, LOVD Individual #00221127, ClinVar SCV000582412.4 internal data communication; c.2272C>T p.(Arg758Cys) x2, 1.0 pt, PMID: 31395899, 22402862). It has also been confirmed in trans with a pathogenic variant in one patient (c.191dup p.(Asn64LysfsTer15), 1.0 pt, ClinVar SCV001574736.5 internal data communication) (PM3_Very Strong). At least one patient with this variant displayed progressive limb girdle muscle weakness (PP4). Two affected family members of a proband with this variant and a second presumed diagnostic ANO5 allele were shown to have the same two variants, but phase was not confirmed (PMID: 22980763; PP1 not met). The filtering allele frequency for this variant is 0.00006 in gnomAD v4.1.0 (the upper bound of the 95% confidence interval of 57/1178734 European (non-Finnish) alleles), which is lower than the VCEP threshold of 0.0001 for PM2_Supporting, meeting this criterion (PM2_Supporting). The computational predictor REVEL gives a score of 0.851, which exceeds the threshold of ≥0.70, evidence that correlates with impact to ANO5 function (PP3). This variant was reported in a heterozygous state in an individual with clinically suspected LGMD who was apparently homozygous for the pathogenic variant c.191dup p.(Asn64LysfsTer15), suggesting the variants occurred in cis on one allele (PMID: 30564623, LOVD Individual #00220749; BP2). However, these variants are predicted on different haplotypes in gnomAD v2.1.1, suggesting it may not be a common complex allele, and this evidence is not considered contradictory with the final classification. 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; 02/10/2026): PM3_Very Strong, PP4, PM2_Supporting, PP3, BP2.