Not sure, but I think that image is made with some help of brushes and stuff… Not as the result of a filters combination…
The way I should do it is this: Make a copy layer, select top one, play with levels and brightness/contrast or whatever suits you, to achieve desired contrast, desaturate (make it b/w), lower the top layer opacity, to see the bottom original layer, take a brush tool, choose size and stuff and start drawing over the top one. Drawing board is perfect for this, but I’m pretty sure you can do descent job only with mouse and keyboard.